scholarly journals P51 Serious pathology mimicking GCA: two cases of carcinoma tongue

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Abdul kayani ◽  
Alwin Sebastian ◽  
Liubov Borukhson ◽  
Madeline Whitlock ◽  
Bhaskar Dasgupta
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Cell Cancer ◽  
Temporal Artery ◽  
Temporal Artery Biopsy ◽  
Alternative Diagnosis ◽  
Poorly Differentiated ◽  
Posterior Tongue

Abstract Background Jaw and tongue pain with constitutional symptoms and raised inflammatory markers are considered pathognomonic ischemic features of giant cell arteritis (GCA). Temporal artery ultrasound (US) (or biopsy) available in GCA fast-track clinics (FTC) for a rapid assessment of patients with suspected GCA. Atypical presentation and negative US or biopsy require further workup to look for an alternative diagnosis. ENT pathology can occur as a mimic of GCA. Herein we discuss two clinical cases of squamous cell cancer tongue presenting with signs and symptoms that resemble GCA. Methods We have put together a case report. Results Case-1: A 58-year-old male with a recent presumed diagnosis of relapsing GCA was referred with worsening visual symptoms and right eye pain despite ongoing steroid treatment (60mg), for consideration of Tocilizumab (TCZ). His initial presentation was 5 months ago with a right parietal and retro-orbital headache and blurred vision. He had a normal eye examination. His C-reactive protein (CRP) was raised (24). He was started on prednisolone 40 mg for GCA with complete resolution of symptoms with normalised CRP within weeks. Several weeks later, symptoms reoccurred. CT brain, abdomen and pelvis was normal and temporal artery biopsy negative. His prednisolone was increased to 60 mg. 6 months later, his jaw and tongue pain worsened, and he was treated with pulsed methylprednisolone. Due to partial response to steroids, he was referred to consider TCZ. He had tender left TMJ with normal temporal artery US. Urgent MRI head and neck revealed a left posterior tongue mass with the histology confirmed poorly differentiated squamous cell carcinoma. He was managed with chemo and radiotherapy. Case-2: A 75 years old female, presented with right scalp pain, tongue pain, painful swallowing and chewing. Her blood investigations were normal except a raised ESR (48) and presumed GCA she was started on steroids (60 mg). she had initially good response but, within a few weeks, her symptoms returned. She was then referred to our FTC. Temporal artery US and biopsy were normal. MRI of the head and neck showed a large mass seen in the right half of the posterior tongue extending into the deep aspect of the anterior tongue. Histology confirmed poorly differentiated Squamous cell carcinoma. She was treated with a combination of chemotherapy and radiotherapy. Conclusion GCA mimics represent a major diagnostic dilemma. FTC helps to stratify the GCA from mimics. Careful evaluation of the history, examination as well as a temporal artery US helps to exclude GCA and aids prompt requesting of appropriate tests to find an alternative diagnosis such as tongue cancers as in our cases. We have now introduced negative weightage for consideration of alternative diagnoses in our GCA probability score. Disclosures A. Kayani None. A. Sebastian None. L. Borukhson None. M. Whitlock None. B. Dasgupta Consultancies; Roche, Sanofi. Grants/research support; Roche.

HPV18 Associated with E-cadherin Expression in Head and Neck Squamous Cell Carcinoma

2018 ◽  
Vol 69 (10) ◽  
pp. 2638-2641 ◽  
Author(s):  
Simina Boia ◽  
Eugen Radu Boia ◽  
Raluca Amalia Ceausu ◽  
Constantin Nicolae Balica ◽  
Ovidiu Alexandru Mederle
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Epithelial Mesenchymal Transition ◽  
Neck Squamous Cell Carcinoma ◽  
Mesenchymal Transition ◽  
Poorly Differentiated ◽  
Well Differentiated ◽  
E Cadherin

HPV is an important oropharyngeal cancer cause, but it may have a role in other head and neck cancers? HPVpositive head and neck squamous cell carcinoma (HNSCC) epithelial-mesenchymal transition role is unclear. We included 38 cases: 20 laryngeal, 3 corresponding lymph nodes; 5 oropharyngeal, 5 hypopharyngeal, 2 rhynopahryngeal, 2 pharyngolaryngeal and 1 naso-sinusal case. Immunoreactivity was positive in nuclear expression cells, accordingly: score 1 (10-30%), 2 (30-50%) and 3 (]50%). HPV18 immunoexpression appeared in 18 cases (47.36%), (11 laryngeal, 4 oropharyngeal, 1 hypopharyngeal, 1 pharyngolaryngeal and 1 naso-sinusal). The score was 1 in larynx well differentiated type. The score was between 1 and 3 in larynx moderately differentiated types, and a significant correlation HPV18/E-cadherin was found (p=0.031). HPV18+/E-cadherin low values were noticed in larynx, oropharynx, pharyngo-larynx and naso-sinusal well and moderately differentiated types. HPV18-/E-cadherin low values were present in larynx, hypo and rhyno-pharynx moderately and poorly differentiated and larynx well differentiated types. Larynx presented HPV18/E-cadherin and moderately differentiated type significant correlation. Rhyno, hypo-pharyngeal and laryngeal presented HPV18�/E-cadherin low values association for moderately, poorly and undifferentiated types. The oropharyngeal location was associated with E-cadherin maximum values, independently of HPV18 status.

251 Factors evaluated as predictors of exceptional response to PD-1 inhibitors in patients with head and neck squamous cell cancer

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A272-A272
Author(s):  
Alexander Song ◽  
Ron Ng ◽  
John Heller ◽  
Robin Petro ◽  
Ralph D’Agostino ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Complete Response ◽  
Similar Treatment ◽  
One Year ◽  
Neck Squamous Cell Cancer

BackgroundImmunotherapy has recently emerged as an alternative to traditional chemotherapy in the management of recurrent or metastatic head and neck squamous cell cancer (HNSCC). PD-1 inhibitors were approved for HNSCC in 2016 with ORR of 13–18% and CR of 4%.1, 2 Current research focuses on identifying predictors of response for better patient selection. We present HNSCC patients with exceptional response to PD-1 inhibitors in an attempt to highlight biomarkers that correlated with their remarkable response.MethodsWe analyzed all cases of HNSCC treated with single agent PD-1 inhibitors in the last 4 years at Wake Forest Comprehensive Cancer Center. To identify exceptional responders, we followed the NIH Initiative definition: complete response to drug(s), where complete response is seen in less than 10% of patients receiving similar treatment or partial response lasting at least 6 months, where such response is seen in less than 10% of patients receiving similar treatment. We aimed to test all patients for PD-L1 expression, tumor genomics by Foundation Medicine platform and mutated circulating tumor DNA via Guardant 360 platform.ResultsBased on the above criteria, 11 patients were identified as exceptional responders, 9 of whom had metastatic spread to lung, liver or bones. 7 patients were treated for more than one year, and all achieved CR. 3 patients were treated for less than one year, and all achieved major PR with possible CR to be confirmed with next scans. One patient with metastatic HNSCC achieved CR after just 3 administrations of PD-1 inhibitor and has been in CR for 3.5 years. 9 patients were tested for PD-L1 before starting immunotherapy, and all presented levels above 5% by TPS and above 10% by CPS. Interestingly, three patients older than 75 had the highest PD-L1: 75% by TPS and 100% by CPS in two patients. TMB was found moderate or high in all 8 patients tested before starting immunotherapy. TP53 was found mutated both in tumor and in blood in all but 2 of the 10 tested patients, one of whom is the only HPV positive patient in our series. MSI was stable in all patients.ConclusionsThere are limited reports in the literature of exceptional responders to immunotherapy, particularly among HNSCC patients. High PD-L1 expression, moderate or high TMB and presence of mutated TP53 in both tumor and blood were present in almost all patients, recommending for further investigations as possible predictors of exceptional response to PD-1 inhibitors.Ethics ApprovalThe study was approved by Wake Forest University Institution’s Ethics Board, approval number IRB00056249.ReferencesT.Y. Seiwert, B. Burtness, R. Mehra, et al. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol 2016;17(7):pp. 956–965.Ferris RL, Blumenschein GJr, Fayette J, Guigay J, Colevas AD, Licitra L, et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med 2016;375:1856–67. 10.1056/NEJMoa1602252

scholarly journals Editorial for the Special Issue “Squamous Cell Cancer of the Head and Neck—Time to Arrive in the 21st Century of Oncology”

2021 ◽  
Vol 22 (4) ◽  
pp. 1592
Author(s):  
Sven Perner ◽  
Christian Idel
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
21St Century ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Special Issue ◽  
Common Cancer

Squamous cell carcinoma of the head and neck (HNSCC) is the sixth most common cancer worldwide [...]

scholarly journals CTIP2 Expression in Human Head and Neck Squamous Cell Carcinoma Is Linked to Poorly Differentiated Tumor Status

PLoS ONE ◽  
2009 ◽  
Vol 4 (4) ◽  
pp. e5367 ◽  
Author(s):  
Gitali Ganguli-Indra ◽  
Christine Wasylyk ◽  
Xiaobo Liang ◽  
Regine Millon ◽  
Mark Leid ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Human Head ◽  
Neck Squamous Cell Carcinoma ◽  
Poorly Differentiated

scholarly journals Continuous infusion of 5-FU with split-dose cisplatin: An effective treatment for advanced squamous-cell carcinoma of the head and neck

2011 ◽  
Vol 34 (1) ◽  
pp. 8 ◽  
Author(s):  
Zhiguo Luo ◽  
Jianhua Chang ◽  
Ye Guo ◽  
Hui Yu ◽  
Fangfang Lu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Intravenous Infusion ◽  
Initial Treatment ◽  
Cell Cancer ◽  
Continuous Intravenous Infusion ◽  
Split Dose ◽  
Overall Response

Purpose: The purpose of this study was to determine if a combination chemotherapy, using continuous intravenous infusion of fluorouracil (5-FU) in combination with split-dose cisplatin, in patients with recurrent or metastatic head and neck squamous-cell could improve previously reported clinical outcomes. Methods: Forty-two patients with recurrent or metastatic head and neck squamous-cell cancer were treated by cisplatin (25 mg/m2/day on days 1-3) and 5-FU (750 mg/m2/day for 120 hours; continuous intravenous infusion on days 1 through 5) with a cycle that repeated every 3 weeks. Results: Of the 42 patients, 8 (19.1%) showed complete response and 12 (28.5%) demonstrated a partial response, giving an overall response rate of 47.6%. Response rates were significantly different for patients undergoing initial treatment vs. re-treatment:73.6% (14/19) vs. 25.9% (6/23), respectively (χ2=9.45, P < 0.05). Median time to progression was 7.2 months and median overall survival was 13.7 months. The 1 year survival was 57.1%. Toxicity mainly included myelo-suppression, mucositis, nausea and vomiting. Conclusion: Chemotherapy with 5-FU by continuous intravenous infusion in combination with split-dose cisplatin is effective with a tolerable toxicity profile in patients with recurrent, or metastatic squamous-cell carcinoma of head and neck. The overall response was significantly higher in patients undergoing initial treatment in comparison with patients undergoing re-treatment after relapse.

Factors Associated with Recurrence and Regional Adenopathy for Head and Neck Cutaneous Squamous Cell Carcinoma

2017 ◽  
Vol 156 (5) ◽  
pp. 863-869 ◽  
Author(s):  
Brianna N. Harris ◽  
Ahmed Bayoumi ◽  
Shyam Rao ◽  
Michael G. Moore ◽  
D. Gregory Farwell ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Chart Review ◽  
Recurrent Disease ◽  
Cutaneous Squamous Cell Carcinoma ◽  
Tumor Diameter ◽  
Primary Tumors ◽  
Poorly Differentiated

Objective Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignancies worldwide. With advanced CSCC of the head and neck, there is conflicting evidence on what constitutes high-risk disease. Our objective is to evaluate which factors are predictive of recurrence and nodal spread and survival. Study Design Case series with chart review. Setting Tertiary academic institution. Subjects and Methods Patients with advanced head and neck CSCC treated with primary resection identified by chart review. Results A total of 212 patients met inclusion criteria, with a mean age of 70.4 years; 87.3% were men. Mean tumor diameter was 3.65 cm, with an average depth of invasion of 1.38 cm. The mean follow-up time was 35 months (median, 21.5), and over that period 67 recurrences were recorded, 49 of which were local. The 5-year Kaplan-Meier estimate of disease-free survival for the cohort was 53.2%. On Cox multivariate analysis, recurrent disease, perineural invasion (PNI), and poorly differentiated histology were independent predictors of recurrence. On multinomial logistic regression, patients with primary tumors on the ear, cheek, temple, or lip, as well as those with PNI, were more likely to present with nodal metastasis. Conclusion For advanced CSCCs of the head and neck, patients with recurrent disease, PNI, and poorly differentiated tumors are at highest risk for local recurrence. Patients with tumors or the ear, cheek, temple, or lip, as well as those with PNI, are at increased risk of harboring nodal disease.

scholarly journals Microsatellite Instability in Head and Neck Squamous Cell Carcinoma: A Study of a Brazilian Population

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Elaine Stur ◽  
Eldamaria de Vargas Wolfgramm ◽  
Allan Kardec de Castro Neto ◽  
Lucas de Lima Maia ◽  
Lidiane Pignaton Agostini ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Microsatellite Instability ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Statistical Significance ◽  
Repair System ◽  
Lack Of Information ◽  
Mismatch Repair System ◽  
Poorly Differentiated

Squamous cell carcinoma (SCC) is the sixth most common solid tumor in the world. Apart from known risk factors for head and neck SCC (HNSCC), there is a lack of information about genetic susceptibility regions that may play pivotal roles in the tumorigenesis of these tumors. Therefore, we have aimed to analyze the presence of genetic instability in microsatellite markers distributed in the genome. Microsatellite instability (MSI) was found in 6 HNSCC patients, among which only one was detected by the D17S250 marker, whereas the other 5 occurrences (13.5%) were detected by the D3S1611 marker. No instability was found at markers D5S346, D10S197, D11S922, and D11S988. MSI detected by D3S1611 marker was present in 3 (14.3%) moderately differentiated tumors and in 2 (25.0%) poorly differentiated tumors, but no statistical significance was found. Genotypic frequencies for all markers showed no statistically significant distribution alteration, neither were they related to differentiation grade or patient age. Marker D3S1611 is located in the MLH1 gene, which is part of the mismatch repair system (MMR), helping to maintain genomic stability. We have found a higher rate of D3S1611 MSI in older patients, suggesting that this marker may be affected by aging processes in the DNA repair machinery.

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