Aged ; Deglutition Disorders ; etiology ; Humans ; Male ; Zenker Diverticulum ; complications ; pathology

Amyloidosis ; pathology ; Humans ; Laryngeal Diseases ; etiology ; Larynx ; pathology ; Male ; Middle Aged ; Nasopharynx ; pathology

OBJECTIVETo study the characteristics of the cervical lymph node metastasis of patients with cN1 supraglottic cancer and to elucidate which levels should be involved during neck dissection.

METHODSModified neck dissections or radical neck dissections were performed for 108 cases (147 sides) of cN1 supraglottic cancer. All the lymph nodes of the samples of 147 operation sides were examined pathologically to identify the metastatic levels.

RESULTSAmong samples of 108 cases (147 sides), 126 lymph nodes were metastasis, among which 113 lymph nodes were located in levels II and III (89.7%, 113/126), and 123 lymph nodes in levels II, III and IV (97.6%, 123/126). The 126 metastatic nodes were distributed in the 109 levels and 96 of them were in the levels II and III (88.1%, 96/109) and 106 were in the levels II, III and IV (97.2%, 106/109). Additionally, 45 cases (63 sides) of the 108 patients were pathologically metastasis (41.7%) and bilateral cervical metastasis occurred in 20 cases (18.5%). The cervical recurrent rate was 7.4% (8/108) and occurred in the levels II, III and IV respectively, during five to fourteen years follow-up.

CONCLUSIONLevels II, III and IV dissection may be reasonable for patients with cN1 supraglottic carcinomas, levels I and V dissection may be avoidable when pathological evidence of metastasis in levels I and V has not been obtained. Contralateral lymph node dissection at the levels II, III and IV should be performed in the case of ipsilateral pN + or contralateral metastasis cN1.

Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; Female ; Glottis ; pathology ; Humans ; Laryngeal Neoplasms ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Staging ; Prognosis

BACKGROUNDStudy on the promotive effects of N-nitrosopiperidine on carcinogenesis process was performed, based on the immortalization of human fetal esophageal epithelium induced by human papillomavirus (HPV) 18E6E7 genes.

METHODSThe immortalized esophageal epithelium SHEE was induced by HPV18E6E7. The cells at 17th passages were cultured in 50 ml flasks. The N-nitrosopiperidine (NPIP) 0, 2, 4, 8 mmol/L added to the cultured medium of SHEE cells for 3 weeks. The morphology, proliferation and apoptosis of the cells were studied by phase contrast microscopy and flow cytometry. Modal number of chromosomes was analyzed by standard method. Tumorigenicity of the cells was assessed by soft agar colony formation and by transplantation of cells into nude mice. Expression of HPV was detected by Western blot.

RESULTSWhen cells were exposed to high concentration (8 mmol/L) of NPIP, cell death was increased, leaving a few live cells. In normal cultural medium instead of NPIP proliferative status of the cells restored after 4 weeks and the cells progressed to the proliferation stage with continuous replication and atypical hyperplasia. At the end of the 8th week, the cells appeared with large colonies in soft-agar and tumor formation in transplanted nude mice. When the cells were cultured in 2, 4 mmol/L NPIP the doubling passage was delayed and without tumor formation in transplanted nude mice. Modal number of chromosomes was 61-65, in 8 mmol/L NPIP group and control group, 56-61. Expression of HPV18 appeared in experimental and control groups.

CONCLUSIONNPIP promotes malignant change of the immortalized esophageal epithelial cells induced by HPV18E6E7. HPV18E6E7 synergy with NPIP will accelerate malignant transformation in esophageal epithelium.

Animals ; Blotting, Western ; Cell Cycle ; drug effects ; Cell Line ; Cell Proliferation ; drug effects ; Cell Transformation, Neoplastic ; drug effects ; Cell Transformation, Viral ; drug effects ; DNA-Binding Proteins ; metabolism ; Epithelial Cells ; cytology ; drug effects ; virology ; Esophagus ; cytology ; Flow Cytometry ; Human papillomavirus 18 ; physiology ; Humans ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasms, Experimental ; metabolism ; pathology ; Nitrosamines ; toxicity ; Oncogene Proteins, Viral ; metabolism

OBJECTIVETo observe the effect of survivin antisense oligodeoxynucleotide (ASODN) on the apoptosis of human carcinoma of larynx cell line Hep2 and the inhibitory rate in nude mice model so as to discuss the selective blocking activity of antisense technique on gene expression seeking a new way for gene therapy of carcinoma of larynx.

METHODSAntisense oligodeoxynucleotides survivin were transformed into human carcinoma of larynx cell line Hep2 by liposome Lipofectamine 2000. Within 72 h after transfection, 3-(4,5-dimethylthiazol-2-yl) -2,5-diphenyltetrazolium bromide (MTT) assay was used to detect cellular proliferation. Forty eight hours after transfection, reverse transcription-polymerase chain reaction (RT-PCR) assay was used to observe the expression of survivin gene, Western Blot assay for the protein, and terminal deoxynucleotide mediated nick end labeling (TUNEL) and flow cytometer for cellular apoptosis.

RESULTSCellular inhibition rate of 72 h went up to 52. 5% and 71.4% at 1.0 micromol/L and 2.0 micromol/L value in Lipo-ASODN groups which differed statistically remarkably (P = 0.046), higher than that in controls in MTT assay (P =0. 003 and 0. 0004). Forty eight hours after transfection survivin gene expression in Lipo-ASODN groups were less than that in control group in RT-PCR assay. Survivin protein expression decreased in Western blot. In TUNEL assay, nuclear positive staining was observed and the apoptosis peak was observed in flow cytometer test, which were absent in controls. In nude mice of carcinoma of larynx model, the inhibitory rate in Lipo-ASODN groups got up to 48.1% and 61.3% higher than that of controls (P < 0.004 and 0. 0006), which differed remarkably (P = 0.032) in a dose-dependently way.

CONCLUSIONSThe findings showed that the expression of survivin gene and protein induced cellular apoptosis in Hep2 cells after transfection of Lipo-ASODN and that the carcinoma of larynx in the nude mice model were inhibited by Lipo-ASODN which suggested that antisense technique can be an effective means in the gene therapy of carcinoma of larynx.

Animals ; Apoptosis ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Female ; Humans ; Inhibitor of Apoptosis Proteins ; Laryngeal Neoplasms ; therapy ; Male ; Mice ; Mice, Nude ; Microtubule-Associated Proteins ; genetics ; pharmacology ; therapeutic use ; Oligonucleotides, Antisense ; genetics ; pharmacology ; therapeutic use ; Transfection

OBJECTIVETo study the pathologic feature and management methods of occult lymphatic metastasis in patients with supraglottic carcinoma.

METHODSThe following are criteria of patients selection: (1) Supraglottic squamous cell carcinoma; (2) Clinical N0M0; (3) no preoperative radiotherapy and (or) chemotherapy. Thirty patients were recruited, male 19 cases, female 11; age: 40 - 72yr, average 54.8yr; T2 8 cases, T3 18, T4 4 (by UICC 1997). Ipsilateral supraomohyoid neck dissections were performed in all cases. Lymph nodes were studied histologically according to the levels of dissection.

RESULTSSix of 30 cases were positive nodes histologically in first operation, 3 were occurrence neck metastasis in opposite side during follow ups. Occult metastasis rate was 20% (6/30) ipsilaterdly and 10% contralaterally. 527 lymph nodes were collected in all of 30 patients, average 17.6 nodes in every side neck. Ten positive lymph nodes histologically were harvested. The distribution of metastatic lymph nodes was 9 in level II, 1 in level III, no in level I. N0 recurrence in larynx and (or) at the neck after dissection. Two years survival rates was 86.7% (26/30) without tumor.

CONCLUSIONOccult metastasis rate of supraglottic carcinoma is as high as 30%. The selective lateral neck dissection of level II, III and occasionally, level IV was recommended.

Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Staging

OBJECTIVETo examine the differential gene expression among adenoid cystic carcinoma ACC-M, low metastasis ACC-2 and low differentiated mucoepidermoid carcinoma MEC-1 with gene array, and detect three important genes with real-time quantitative PCR.

METHODSGene array was used to screen the differential genes, then three important genes were selected and detected by real-time quantitative PCR.

RESULTSThe gene contents of MDR-1, MRP-1 and CCD1 were MEC-1 > ACC-M > ACC-2, MEC-1 > ACC-M > ACC-2 and MEC-1 > ACC-M > ACC-2 respectively.

CONCLUSIONSDrug resistance of MEC-1 is related with high content of MDR-1. High metastasis of ACC-M is concerned with high content of MRP-1 and low content of CCD-1. Low metastasis of ACC-2 has a relationship with low content of MRP1.

Carcinoma, Adenoid Cystic ; genetics ; Carcinoma, Mucoepidermoid ; genetics ; Cell Line, Tumor ; Drug Resistance, Neoplasm ; genetics ; Gene Expression Regulation, Neoplastic ; Genes, MDR ; Humans ; Neoplasm Metastasis ; genetics ; Oligonucleotide Array Sequence Analysis ; Polymerase Chain Reaction ; Salivary Gland Neoplasms ; genetics

OBJECTIVETo evaluate the feasibility of routine inclusion of levels II and III in neck dissection to treat the occult neck metastasis as elective treatment for supraglottic cancer with clinically node negative (cN0).

METHODSThe results of 52 cN0 patients with supraglottic cancer treated in Tumor Hospital, Harbin Medical University from October 2002 to March 2006 were reviewed retrospectively.

RESULTSOf the 52 patients with supraglottic cancer and cN0 neck, 32 cases received ipsilateral SND (levels II and III) and 20 cases with bilateral SND (levels II and III). Fifteen (28.9%) of 52 patients were found to have occult regional metastasis on pathological examination. Three patients without metastasis in dissected side at pathologic examination showed metastasis in the contralateral undissected neck later on therefore the total occult metastasis rate was 34.6% (18 of 52). The unilateral and bilateral neck occult metastases were determined in 15 cases (28.9%) and 3 cases (5.8%) respectively. A total of 1190 lymph nodes were harvested in 72 specimens, with 30 positive nodes. The distributions of the 30 positive nodes were as follows: level IIA 83.3% (25 nodes), level III 16.7% (5 nodes). Three-year regional recurrence rate was 5.8%. The 3-year survival rate was 84.6% according to Kaplan-Meier in all cN0 patients (n = 52). Patients with positive neck metastasis and patients with extracapsular spread had higher regional recurrence rates (P = 0.021 and 0.002, respectively).

CONCLUSIONSThe results support the use of SND (levels II and III) in cN0 supraglottic cancer. This procedure will reduce both operating time and morbidity, without compromising the oncologic result.

Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Glottis ; pathology ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neck Dissection ; methods ; Neoplasm Recurrence, Local ; surgery ; Neoplasm Staging ; Retrospective Studies

OBJECTIVETo evaluate the clinical value of supraglottic horizontal partial laryngectomy.

METHODSOne hundred and sixty-three patients with supraglottic laryngeal carcinoma were treated surgically by supraglottic horizontal partial laryngectomy from 1978 to 1998. There were 64 males and 99 females. Five cases were staged I, 95 staged II, 48 staged III and 15 staged IV. The surgical techniques were improved: The hyoid was removed conventionally; The outer perichondrium of thyroid cartilage was turned into the laryngeal cavity and sutured with the mucosa of laryngeal ventricle and the base of tongue was sutured to the reserved thyroid cartilage. Survival was evaluated using the Kaplan-Meier method. The differences between stages were tested by Los-Rank method.

RESULTSThe 5-year survival rate were 100.0%, 77.9%, 54.2% and 33.3% for patients staged I to IV respectively, and were statistically significant (P = 0.0006) between different clinical stages. The 5-year survival rate were 73.1% and 45.5% in patients with cN0 and cN + respectively, and were statistically significant (P = 0.0132). The speech and swallowing functions were good after operation. The decannulation rate was 91.4%. The main causes of death were cervical lymph node metastasis in 40% (20/50) and laryngeal recurrence in 18% (9/50). The occult metastasis rate was 23.1% (30/130) and cervical metastasis rates of patients with cN1-3 75.8% (25/33), with a total metastasis rate was 33.7 (55/163).

CONCLUSIONSSupraglottic horizontal partial laryngectomy is very effective in eradicating disease and in preserving laryngeal function on condition that the indications were selected correctly. The selective lateral neck dissection was recommended for supraglottic carcinoma.

Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Female ; Glottis ; pathology ; surgery ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Neck Dissection ; Treatment Outcome

OBJECTIVETo discuss the long-term results of the subtotal laryngectomy with preservation of an arytenoids cartilage.

METHODSThe long-term results of the subtotal laryngectomy with preservation of an arytenoids cartilage were analysed in 82 patients with squamous cell carcinoma of larynx (stage III 73 cases, IV 9 cases; supraglottic type 71 cases, glottic 6, transglottic 5).

RESULTSThe functions of speech and deglutition were recovered in 82 patients, and the respirations were normal in 69 of 82 cases (84.2%). Pharyngeal fistula appeared in 2 cases, and the infection of incision wound in 6, but all of them were cured by conservative treatment. All of 82 cases were followed-up for more than 5 years, 5 cases were lost follow-up, so the follow-up rate was 93.3%. 26 patients died of various causes during 5 years after operation. 5 of 26 cases died of local recurrence of laryngeal carcinoma, neck metastasis in 4, others in 4 (cardiac insufficiency, myocardiac infarction, lungs metastasis, rectal carcinoma 1 case, respectively) unknown in 4, lost follow-up in 5.68 patients were followed-up for more than 10 years, 30 cases were dead (26 cases who died of various causes included during 5 years after operation; died of local recurrence in larynx was 1 case, unknown 2, lost follow-up 1, during 5 approximately 10 years after surgery). 5, 10 years survival rates were 68.3% (56/82) and 55.9% (38/68), respectively.

CONCLUSIONSSubtotal laryngectomy with preservation of an arytenoids cartilage is recommended for T3 and some elective T4 laryngeal carcinoma.

Adult ; Aged ; Arytenoid Cartilage ; Carcinoma, Squamous Cell ; surgery ; Disease-Free Survival ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Treatment Outcome