[Show abstract][Hide abstract] ABSTRACT: Malignant neoplasms of the larynx are divided into epithelial and non-epithelial. Non-epithelial neoplasms include, among others, mesenchymal chondrosarcomas and osteosarcomas. Few cases of laryngeal osteosarcomas described in the literature were usually treated by surgery without the need to use adjuvant radioor chemotherapy. Few authors propose the initial application of radiotherapy or high-dose chemotherapy. Our study presents a very rare case of a woman treated due to laryngeal osteosarcoma. We have also presented diagnostic difficulties preceding a decision to perform radical surgery. The patient had been eligible for radical surgical treatment, even though there were no features of malignancy in a histopathological examination of the biopsy material. Complete laryngectomy was carried out without the surgery of the cervical lymphatic system. Laryngeal osteosarcoma was diagnosed based on the postoperative histopathological examination using vimentin and Ki67. The patient remains under the care of the Otolaryngology and Laryngological Oncology Department and Oncology Centre in Bydgoszcz. There were no reports on local recurrence or distant metastases during regular check-ups.
[Show abstract][Hide abstract] ABSTRACT: Non-Hodgkin lymphoma of Waldeyer's ring constitutes a small percentage of cases of palatine tonsil malignancies and its precise etiology remains unknown. RCAS1 (receptor cancer-binding antigen expressed on SiSo cells) has been demonstrated to be associated with poor prognosis, the development of lymph node metastases and participation in tumor microenvironment remodeling. Our aim is to analyze the potential role of RCAS1 expression in the tumor and tumor microenvironment in the development of early-stage palatine tonsil B-cell lymphomas. We selected 20 patients and analyzed tissue samples from the lymphoma and tumor microenvironment of each patient and from a reference group of 20 patients with chronic tonsillitis. The presence of RCAS1 protein immunoreactivity was demonstrated in 65 % of the examined tissue samples of diffuse large B-cell lymphoma and in 25 % of the analyzed stromata in which it was exhibited by CD68-positive cells identified as macrophages and dispersed throughout the stroma. RCAS1 immunoreactivity in the lymphoma tissue samples remained at a level comparable with that of the reference and was significantly higher in these samples than in those from the stroma. Chronic inflammation of the palatine tonsils thus results in intensive infiltration by various types of immune system cells and in excessive RCAS1 immunoreactivity, both of which confirm the important regulatory role of RCAS1 in the immune response in the mucosa-associated lymphatic tissue of Waldeyer's ring. RCAS1 seems to be involved in creating tumor-induced inflammation in the tumor and its microenvironment.
Cell and Tissue Research 03/2015; 361(3). DOI:10.1007/s00441-015-2157-0 · 3.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Laryngeal squamous cell carcinoma (LSCC) is still a problem worldwide. In some publications interactions between the expression of matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, and their tissue inhibitors (TIMPs) implicated during cancer progression were suggested.Methods
The immunohistochemical staining using primary antibody against MMP-2, MMP-9, TIMP-1, TIMP-2, and TIMP-3 were performed. The research group consists of primary N(0) LSCC (20 cases), primary N(+) LSCC (17 cases), and 18 cases of normal mucosa.ResultsStudied MMPs and TIMPs were localized in tumor cells and tumor stroma compartment. MMP-2 expression was higher in stroma compared to tumor cells. MMP-9, TIMP-1, TIMP-2, and TIMP-3 expression was higher in tumor cells than in tumor stroma (P < 0.05). In tumor stroma MMP-2, MMP-9, TIMP-1, and TIMP-3 expression, in LSCC N(0) vs. LSCC N(+) was significantly higher (P < 0.05). The ratios between MMP-2 and TIMP-3 expression were statistically significant (N(0) vs. N(+); P = 0.012). The analyses using classification trees predicted the probability of metastases according to TIMP-3/MMP-14/MMP-2 and MMP-9/TIMP-1 expression levels.Conclusions
The presence of MMP-2, MMP-9, TIMP-1, TIMP-2, TIMP-3 expression in tumor cells and in tumor stroma, and additionally different expression according to lymph node involvement suggested of their impact during cancer progression. The significant correlation between TIMP-3 expression and the presence of lymph node metastases and MMP-2 expression might suggest the importance of TIMP-3 as a prognostic factor during tumor progression. The evaluation of molecular markers which participate in MMP-2 activation pathway have a major impact during metastasis.
Journal of Oral Pathology and Medicine 09/2014; 44(6). DOI:10.1111/jop.12270 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Inadequate surgical field visualization due to intraoperative bleeding during endoscopic sinus surgery (ESS) can cause major complications. The aim of this prospective study was to compare the effect of preoperative administration of clonidine and melatonin on the quality of the surgical field visualization and selected aspects of presurgical premedication.
Twenty-six patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or melatonin as preoperative premedication. During the operation, the quality of the surgical field was assessed and graded using the scale proposed by Boezaart. The evaluations were done at 15, 30, and 60 minutes after incision. The effect of this premedication choice on the intraoperative and postoperative hemodynamic profile was examined in each group. Anxiolytic effects of both premedication agents were assessed using the visual analogue scale for anxiety (VAS-A). Propofol dose and induction time (the time for bispectral index [BIS] to reach 45), anesthesia and surgical procedures time, and recovery time (the time for BIS to reach 90) were assessed in both groups as well.
The quality of the surgical field was consistently better in 2 of 3 time points in the clonidine group. Perioperative mean arterial pressure and intraoperative heart rate had a more favorable profile in patients premedicated with clonidine. There were no differences in other measured parameters between groups.
Premedication with clonidine before ESS provides better quality of surgical field and more favorable hemodynamic profile as compared to melatonin.
International Forum of Allergy and Rhinology 07/2014; 4(7). DOI:10.1002/alr.21308 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although retrograde menstruation is observed in up to 90% of women, endometriosis actually develops in only 15% of women. There is considerable evidence in the literature that ectopic endometrial cells are able to evade immune surveillance and that the immune response in the microenvironment of ectopic lesions is limited. Endometriosis develops when a deficiency in the local immune response has been generated, and progression of the disease is related to the intensity of this process. Over the last couple of decades it has been well known that T regulatory lymphocytes (Tregs) play a crucial role in controlling a variety of physiological and pathological immune responses. In this review we have focused on the physiological alteration of Treg cell infiltration into the endometrium during the reproductive processes of women. We discuss how a disturbance in Treg cell expansion is involved in generating such pathological processes as miscarriage and ectopic pregnancy development. We hypothesize about the role Treg cells might play in the survival of endometriosis foci in ectopic localization and in the evasion of such lesions from host immune surveillance.
Histology and histopathology 05/2014; 29(10). · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) can decompose extracellular matrix components and brake down basement membranes and thus, promote tumor local invasion and metastasis. Material and methods: We studied 41 patients with squamous cell carcinoma (SCC) of oropharynx who underwent surgical treatment. Material was diagnosed by routine procedure and examined by immunohistochemical analysis and dot blot technique. We search for correlations between expressions of matrix metalloproteinases such as MMP-2, MMP-9 and their tissue inhibitors TIMP-1 and TIMP-2 and treatment outcome. Results: We found cytoplasmic expression of analyzed proteins, both in cancer cells and tumor stroma. The expression of analyzed antigens was higher in patients with lymph node metastases comparing patients without lymph node involvement. Conclusion: Our data suggest that microenvironment changes are one of key factors in tumor progression. Divergent expression of matrix metalloproteinases and their inhibitors might be used as prognostic factor of oropharyngeal carcinoma progression. Head Neck, 2014.
Head & Neck 01/2014; DOI:10.1002/hed.23618 · 2.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: During functional endoscopic sinus surgery (FESS), intraoperative bleeding can significantly compromise visualization of the surgical field. Clonidine constricts peripheral blood vessels and reduces systemic blood pressure, which in combination decrease nasal mucosa blood flow. This dual effect can potentially reduce bleeding during FESS and stabilize the intraoperative hemodynamic profile of the patient.
The aim of this prospective study was to assess if the quality of the surgical field visualization during FESS was improved when clonidine was used as a premedication agent.
A group of 44 patients undergoing FESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as preoperative premedication. During the operation, the quality of the surgical field was assessed and graded by the operating surgeon using the scale proposed by Boezaart. The evaluations were done during surgery at 15 minutes (K1), 30 minutes (K2), 60 minutes (K3) and 120 minutes (K4) after incision.
The duration of the surgical procedure was significantly shorter in the clonidine group: mean time of surgery: 80 vs. 96 min in the clonidine and midazolam groups, respectively. Also better quality of surgical field was observed at all time points in the clonidine group.
Premedication with clonidine before FESS results in shortening of the surgical time and a better quality of the surgical field.
[Show abstract][Hide abstract] ABSTRACT: The cancer microenvironment makes up the stroma of the neoplasm and is the tissue that determines tumor growth, progression, and ability to initiate metastases. Because of the role that the cancer microenvironment plays in each stage of tumor development, knowledge about the interactions of the tumor with its microenvironment would seem to be of the utmost importance for developing new treatment strategies. The cancer microenvironment is created by the tissue surrounding the tumor cells and is composed of cells, extracellular matrix, and the proteins of the extracellular matrix. Although tumor cells are capable of penetrating the surrounding stroma, it is the tumor stroma that provides the necessary blood supply and growth factors for the tumor cells that condition tumor growth. In the present review we discuss the role of various cells like tumor-associated macrophages and cancer-associated fibroblasts, expressing RCAS1, B7-H4 molecules, and MT in creating the suppressive profile of the cancer microenvironment and in the cancer microenvironment remodeling that enables both local tumor spread and the creation of metastases.
Frontiers in Bioscience 06/2013; 18(3):1003-16. DOI:10.2741/4159 · 3.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Problem:
The tumor microenvironment is made up of tissue that is responsible for the growth and progression of the tumor as well as its ability to initiate metastases. The cancer cells on the front of the tumor together with the macrophages and fibroblasts help to constitute the aggressive phenotype of the tumor. The presence of this aggressive phenotype is indicated by the local infiltration of cancer cells and by the development of lymph node metastases. In cases of uterine cancer, the extent of the local and distant spread of the disease is crucial for determining the type of therapeutic strategy to be applied - surgery alone, surgery followed by radio-chemotherapy, or radio-chemotherapy alone. In the interest of trying to improve the patient's quality of life, different studies supporting the therapeutic model of surgery alone have been conducted. While the cancer cells on the tumor front together with the macrophages and the fibroblasts help to constitute the aggressive phenotype of the tumor, metallothionein (MT) has been shown to have both pro-proliferative and anti-apoptotic activities and to participate in microenvironment remodeling. The aim of the current study was to determine the levels of MT immunoreactivity in the uterine cervical cancer cells as well as in the stromal fibroblasts and macrophages of the tumor microenvironment with respect to the depth of the local invasion and the extent of the distant metastases, so that its potential predictive value as a therapeutic strategy for cervical cancer can be ascertained.
We determined the levels of immunoreactivity of MT in a total of 57 carcinoma tissue samples (in the tumor front, in its central part, and in the macrophages and fibroblasts present within the tumor microenvironment). The patients from whom the samples derived were divided into groups with respect to the presence of lymph node metastases (distant spread) and to the depth of invasion (local spread) in relation to the FIGO stage.
Metallothionein immunoreactivity was observed in uterine cervical cancer cells; it was also identified in the fibroblasts and macrophages found within the microenvironments of the tumors of patients suffering from the disease. The MT immunoreactivity level significantly increased within the whole cancer nest in relation to the FIGO stage (intensity of the local spread of the disease). Similarly, the infiltration of MT-positive CAFs and TAMs statistically significantly increased in relation to the FIGO stage.
The level of MT immunoreactivity found in the fibroblasts and macrophages within the tumor microenvironment seems to be indicative of the intensity of the remodeled cervical tumor microenvironment, and this in turn may be related to the local advancement of the disease. Moreover, it appears that the intensity of the metallothionein immunoreactivity in the immunoreactivity profile of the cervical tumor may be linked to both the depth of the local invasion and the extent of the distant advancement of the disease.
American Journal Of Reproductive Immunology 04/2013; 70(3). DOI:10.1111/aji.12120 · 2.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cancer progression involves multiple proteolytic interactions, with metalloproteinases (MMPs) performing a crucial role. MMP-2, a major MMP, plays a key role in the degradation of basement membranes. Mechanisms underlying MMP-2 activation had to be investigated. Membrane-type matrix metalloproteinases are not only responsible for the regulation of extracellular matrix remodeling, but also involved in the activation of several inactive MMPs. The aim of this study was to evaluate the expression of pro-MMP2, MMP-14, and MMP-15 in tumor cells and tumor stroma. Immunohistochemical studies were performed on paraffin-embedded tissue sections including laryngeal squamous cell carcinoma (SCC). We found the expression of pro-MMP2 in 58% of cases, MMP-14 in 78%, and MMP-15 in 98% of cases of SCC. In all tumor cases, we revealed a higher expression of pro-MMP2 in tumor stoma than in tumor cells. The expression of MMP-14 and MMP-15 was higher in tumor cells than in the stroma. Moreover, we found a statistically significant difference between the expression of MMP-14 and MMP-15 in the tumor in comparison with the surrounding stroma (P < 0.05). An analysis of expression levels of MT-MMPs by classification trees showed that the probability of metastases was related to decreased expression of MMP-14 and increased expression of MMP-15. Our results may suggest that tumor cells with low MMP-14 expression invade tumor stroma and form metastases. Probably, in such cases, tumor progression is stimulated by MMP-15 in an MMP-14 independent pathway, a novel (alternative) mechanism.
Journal of Oral Pathology and Medicine 03/2013; 42(3):267–274. DOI:10.1111/jop.12000 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Metallothionein (MT) has been shown to have pro-proliferative anti-apoptotic activity and to be involved in microenvironment remodeling. The aim of this study has been to determine whether the changes in MT and vimentin immunoreactivity observed in cancer and its microenvironment are related to the local spread of the disease. The immunoreactivity levels of both MT and vimentin were evaluated together with CD56 and CD57 antigens in 49 tissue samples taken from patients with squamous cell carcinoma originating from the palatine tonsils and in 20 tissue samples derived from patients with chronic tonsillitis (the reference group). MT immunoreactivity levels were statistically significantly higher in the tissue samples from squamous cell carcinoma than in those of the reference group and also higher in the squamous cell carcinoma samples compared with the stromal samples. Moreover, stromal fibroblasts exhibited high vimentin and MT immunoreactivity levels. Statistically significantly higher MT immunoreactivity levels within the tumor cells were identified in patients with the presence of lymph node metastases in contrast to those patients without such metastases. Vimentin was detected in both the tumor and the stromal tissue samples and presented an interesting pattern of staining strongly expressed within the stroma and the septal architecture of the tumor. The number of CD56- and CD57-positive lymphocytes identified in tissue samples both from squamous cell carcinoma and from the stroma was statistically significantly lower than that in the reference group. MT expression by tumor cells is thus associated with an aggressive phenotype of the tumor and the ability to create metastases.
Cell and Tissue Research 02/2013; 352(2). DOI:10.1007/s00441-013-1566-1 · 3.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Kartagener's syndrome is a rare autosomal recessive disorder presenting a triad of sinusitis, bronchicetasis and situs inversus with dextrocardia. It occurs in 50% of patients with situs inversus. The most important anesthetic implications of Kartegener's syndrome surgery are assessement of pulmonary and cardiac structure and function. We present a case of 43-year-old woman with chronic rhinosinusitis with polyps and bilateral sectetory otitis media. The chest radiograph and CT scans showed dextrocardia and situs inversus with chronic bronchitis without bronchiectasis. Spirometry showed forced expiratory volume in one second (FEV1) of 2.66 L and forced vital capacity (FVC) of 3.62 L. Electroechography showed no cardiac abnormalities with 55-60% of EF. The anesthetic implications of Kartagener's syndrome are varied. The regional or general anesthesia might be involved with sinus surgery, ear surgery, pulmonary surgery, infertility or abdominal and cardiac surgery. The main anesthetic considerations among patients with Kartagener's syndrome are related to the pulmonary function which include preoperative respiratory infections due to bronchiectasis. We should also monitor potentially occluded congenital heart diseases. Kartagener's syndrome is a rare disease and when the patient need an operation we have to consider surgery with regional or general anesthesia. The general anesthesia would be safe after complete preanaesthetic examination of the patient. The ECG, chest CT scans, spirometry and echocardiography are mandatory before the operation.
Otolaryngologia polska. The Polish otolaryngology 07/2012; 66(4):291-4. DOI:10.1016/j.otpol.2012.05.020
[Show abstract][Hide abstract] ABSTRACT: Helicobacter pylori is the most common etiological factor of chronic infection worldwide. It has also been found in human dental plaques, mouth, saliva, tonsils and adenoid tissue, medial ear or nasal polyps and sinuses mucosa, as well in several benign and malignant lesions of the larynx and pharynx. The aim of the study was to investigate the association of H. pylori colonization in chronic rhinosinusitis and benign laryngeal diseases.
The prospective, controlled study involved a series of 30 patients with nasal polyps and normal nasal mucosa and 30 patients with benign laryngeal diseases. Samples of 10-15 mg obtained from fresh tissues were used for nucleic acid purification. All samples were subjected to H. pylori ureA detection by the PCR H. pylori diagnostic test. Samples that were positive for ureA H. pylori gene were evaluated for cagA H. pylori gene.
H. pylori DNA (ureA gene) was detected in all patients with nasal polyps, concha bullosa and laryngeal diseases. Presence of H. pylori cagA gene was identified in 7 (23.3%) of 30 patients of H. pylori-positive larynx samples and no positive result was observed in nasal polyps and concha bullosa.
Our results reveal the presence of H. pylori DNA in nasal polyps, concha bullosa and benign larynx diseases. cagA-positive H. pylori was observed only in laryngeal tissues. These results may have implications for a possible role of H. pylori in laryngeal diseases.
Archives of medical research 11/2011; 42(8):686-9. DOI:10.1016/j.arcmed.2011.12.005 · 2.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Silent sinus syndrome (SSS) is rare clinical entity described in ophthalmology and otolaryngology literature. It is characterized by spontaneous and progressive enophthalmos and hypoglobus caused by maxillary collapse in the setting of chronic maxillary sinus hypoventilation. The authors report an unusual case of SSS in child.
A 15 year old boy presented with 6 months history of developing of right cheek deformity with no clinically signs and symptoms of chronic rhinosinusitis. According to nasal endoscopy and CT and NMR scans the silent sinus syndrome was recognized. What is the most important, the deformity of anterior maxillary wall was the main problem and complaint. The patient underwent surgical endoscopic uncinectomy with medial antrostomy.
The performed treatment successfully corrected both the cheek and the upper eyelid sulcus deformity. The control CT scans performed 3 months after surgery showed normal sinus ventilation with wide medial antrostomy.
Silent sinus syndrome in a child is characterized by more active resorption and remodeling of anterior maxillary wall with clinically visible deformity. The goal of the treatment is restoration of normal maxillary sinus aeration and this guaranty further normal sinus development.
Otolaryngologia polska. The Polish otolaryngology 02/2007; 61(4):458-62.
[Show abstract][Hide abstract] ABSTRACT: A mucoepidermoid carcinoma is a rare disease of the salivary glands. It usually occurs as a small tumor (a few centimeters diameter). The most important diagnostic procedure for the treatment is a histological examination. MATERIAL ET METHODS: We present the case of 71 years old woman with giant in size tumor of the left parotid gland. The tumor had developed in the three years' time and no paresis of the facial nerve had occurred during that time. Preoperative fine needle aspiration biopsy of the parotid gland masses showed pleomorphic adenoma cells.
The surgery treatment was introduced. The function of the facial nerve was preserved. The histological examination result was mucoepidermoid carcinoma. We observed local recurrence of the tumor five months after the operation. But there was still no facial nerve paralysis. The patient was submitted to the radiotherapy treatment.
The big size of the tumor may be an obstacle in full resection during an operation. The false negative results during a fine needle aspiration and preserved normal function of the facial nerve can cause correct treatment as an extremely difficult goal.
Otolaryngologia polska. The Polish otolaryngology 02/2006; 60(6):959-63.