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Cirka 300 000 individer drabbas årligen i världen av oral cancer och mer än nittio procent av alla orala cancerformer utgörs av skivepitelcancer. Den femåriga prognosen är generellt 50 % och den 5-åriga relativa överlevnaden har under en tioårsperiod förblivit densamma. Detta motiverar utvecklingen av bättre prognostiska markörer och diagnostiska metoder för att tidigt identifiera de patienter som har risk att utveckla oral skivepitelcancer för att förbättra prognosen och minska lidandet genom tidig insatt behandling. β-catenin är en adhesionsmolekyl som är viktig för bibehållandet av cellulär integration och avvikelser i celladhesionsmolekyler tros spela en central roll när tumörceller invaderar närliggande vävnad det vill säga metastaserar till andra organ.Syftet med studien är att med hjälp av immunohistokemi undersöka om β-catenin kan fungera som en prognostisk markör för utvecklingen av oral skivepitelcancer. Detta görs genom att jämföra förekomsten av β-catenin med hjälp av monoklonala antikroppar i normalt skivepitel, dysplasi och cancer från 18 patienter som har diagnostiserats med oral skivepitelcancer. Infärgningen av Beta catenin jämfördes i normalt oralt skivepitel med cancer och dysplasi för alla biopsier för att undersöka om det förekommer någon skillnad av infärgningen. Förutom detta skedde även en jämförelse av normalt skivepitel med dysplasi och cancer inom varje enskild biopsi.Resultaten visade att det finns en skillnad i uttrycket av β-catenin i normalt skivepitel jämfört med dysplasi och cancer i denna patientgrupp. I denna studie visade mer än 70 % av biopsierna en stark eller måttlig och stark infärgning av β-catenin i normalt skivepitel, mer än 60 % av biopsierna visade en måttlig eller måttlig och svag infärgning av dysplasi och 58,8 % av alla biopsier visade svag infärgning eller ingen och svag infärgning av skivepitelcancer. Då studien visar att mängden av β-catenin är starkast i normalt oralt skivepitel, måttligt i dysplasi och svagast i cancer tyder detta på att β-catenin skulle kunna vara en viktig faktor i utvecklingen av skivepitelcancer i munhålan vilket stämmer väl överens med resultat från andra studier. / Approximately 300,000 individuals are affected every year in the world of oral cancer and more than ninety percent of all oral cancers consists of squamous cell carcinoma. The five-year prognosis is generally 50 % and the 5-year relative survival has over ten years remained the same. This motivates the development of better prognostic markers and diagnostic methods for the early identification of patients at risk of developing oral squamous cell carcinoma to improve prognosis and reduce the suffering of these patients with early treatment.β-catenin is an adhesion molecule that is important for the maintenance of cellular integration and abnormalities of cell adhesion molecules is thought to play a central role in tumorigenesis. The abnormalites is though to enhance tumour cells to break loose from neighbouring cells and invade nearby tissues and organs, however the exact mechanisms are unknown. The purpose of the study is that using immunohistochemistry to examine whether β-catenin may serve as a prognostic marker for the development of oral squamous cell carcinoma. This is done by examining the presence of β-catenin with monoclonal antibodies in 18 biopsies with normal squamous epithelia, dysplasia and cancer from 18 patients diagnosed with oral squamous cell carcinoma from the department of Oral Pathology at Malmö Högskola, Malmö. The staining of beta catenin was compared in normal oral squamous cancer and dysplasia for all biopsies to see whether there is any difference of dyeing. Besides this, there was also a comparison of normal squamous epithelium with dysplasia and cancer in each biopsy.The results showed that there is a difference in the expression of β-catenin in normal squamous epithelium, dysplasia and cancer in this population. In this study, more than 70 % of the biopsies expressed a strong or moderate and strong staining of β -catenin in normal oral squamous epithelium, more than 60 % of the biopsies showed a moderate or moderate and weak staining of dysplasia and 58.8 % of all biopsies showed weak or no staining and weak staining of squamous cell carcinoma.As the study shows that the amount of β -catenin is strongest in normal oral squamous epithelium, moderate in dysplasia and weakest in cancer, this suggests that β -catenin could be an important factor in the development of squamous cell carcinoma of the oral cavity which is in line with results from other studies.

Yes / Recently a sub-population of cells with stem cell characteristics, reported to be associated with initiation, growth, spread and recurrence, has been identified in several solid tumors including oral tongue squamous cell carcinoma (OTSCC). The aim of our pilot study was to isolate CD44+ cancer stem cells from primary cultures of OTSCC and neck node Level I (node-I) biopsies, grow cell spheres and observe their characteristics in primary cultures. Parallel cultures of hyperplastic lesions of tongue (non-cancer) were set up as a control. Immunohistochemistry was used to detect CD44/CD24 expression and magnetic activated cell sorting to isolate CD44+ cell populations followed by primary cell culturing. Both OTSCC and node-I biopsies produced floating spheres in suspension, however those grown in hyperplastic and node-I primary cultures did not exhibit self-renewal properties. Lymph node metastatic OTSCC, express higher CD44/CD24 levels, produce cancer cell spheres in larger number and rapidly (24 hours) compared to node negative OTSCC (1 week) and non-cancer specimens (3 weeks). In addition, metastatic OTSCC have the capacity for proliferation for up to three generations in primary culture. This in vitro system will be used to study cancer stem cell behavior, therapeutic drug screening and optimization of radiation dose for elimination of resistant cancer cells. / SKMCH&RC, Yorkshire Cancer Research

Postoperative delirium (POD) is an acute and serious complication following extended surgery. The aim of this study was to identify possible risk factors and scores associated with POD in patients undergoing reconstructive head and neck surgery. A collective of 225 patients was retrospectively evaluated after receiving reconstructive surgery in the head and neck region, between 2013 to 2018. The incidence of POD was examined with regards to distinct patient-specific clinical as well as perioperative parameters. Uni- and multivariate statistics were performed for data analysis. POD occurred in 49 patients (21.8%) and was strongly associated with an increased age-adjusted Charlson Comorbidity Index (ACCI) and a prolonged stay in the ICU (p = 0.009 and p = 0.000, respectively). Analogous, binary logistic regression analysis revealed time in the ICU (p < 0.001), an increased ACCI (p = 0.022) and a Nutritional Risk Screening (NRS) score 6= 0 (p = 0.005) as significant predictors for a diagnosis of POD. In contrast, the extent of reconstructive surgery in terms of parameters such as type of transplant or duration of surgery did not correlate with the occurrence of POD. The extension of reconstructive interventions in the head and neck region is not decisive for the development of postoperative delirium, whereas patient-specific parameters such as age and comorbidities, as well as nutritional parameters, represent predictors of POD occurrence.

A cirurgia micrográfica de Mohs (CMM) é realizada em fases sucessivas de retirada tumoral. Cada fase demora de uma a duas horas, dependendo do tamanho da lesão; portanto, é muito importante conseguir predizer o número de fases da cirurgia a fim de poder programar melhor o tempo de uso da sala cirúrgica e da equipe cirúrgica, o uso de anestésicos, os custos da cirurgia, melhor orientar o paciente e assegurar a remoção completa do tumor. Com o intuito de encontrar fatores preditivos do número de fases da CMM no tratamento do carcinoma espinocelular da cabeça, realizou-se o levantamento dos prontuários de 44 pacientes submetidos a 51 CMM no ambulatório de cirurgia dermatológica da Divisão de Dermatologia do HC-FMUSP/SP, de 1994 a 2003. Foram constituídos três grupos quanto ao número de fases da CMM: uma fase, duas fases e três ou mais fases. Os grupos foram comparados em relação às variáveis: duração da lesão até a cirurgia, morfologia, tamanho e limites da lesão, tumor primário ou recidivado, grau de diferenciação histológica do tumor e localização anatômica do tumor. Identificou-se um único fator significante na análise univariada: a distribuição dos tumores recidivados segundo o número de fases da cirurgia e que diferiu da distribuição dos tumores primários (p=0,081, teste exato de Fisher), sendo maior o número de fases para os tumores recidivados. Na análise multivariada, não houve fatores estatisticamente significantes que pudessem estar associados ao número de fases da cirurgia. Na análise da razão de chances, observou-se maior chance de apresentar maior número de fases para as variáveis: limites clínicos imprecisos, tumor ulcerado, tumor recidivado, tumor mais agressivo histologicamente e tumor maior que 1 cm. / Mohs micrographic surgery (MMS) is proceeded in successive stages of cancer removal. Each stage lasts from 1 to 2 hours, depending on the tumor size. So it is very important to predict the number of phases of the surgery so that one can plan better the time of the surgical room use, the time of the surgeon and his team, the use of anaesthetics, the surgical costs, to give the patient better orientations about his surgery and to ensure complete tumor erradication. With the intention to find predictive factors of the number of stages of MMS in the treatment of squamous cell carcinoma, we reviewed the record of 44 patients on a total of 51 surgeries proceeded in the dermatologic surgical clinic of the Dermatological Division of HC-FMUSP/SP from 1994 to 2003. For the number of stages in the MMS we established 3 groups: 1 stage, 2 stages and 3 or more stages. These groups were compared with regard to this variables: continuance of the lesion until the surgery, morphology and size of the lesion, lesion limits, primary or recurrent cancer, histological grade (Broders) and anatomic localization. In the univariated analysis one single factor was significant: the distribution of the recurrent cancers related to the number of stages of the surgery that was different from the distribution of the primary ones (p=0.081, Fisher\'s exact test), been higher the number of stages for the recurrent cancers. In the multivariated analysis, there were no statistically significant factors associated with higher number of stages of the surgery. In the analysis of the odss ratio, we noted a higher chance of a higher number of stages for the variables: inaccurate clinical limits, ulcerated lesions, recurrent cancer, higher aggressive histology and tumor bigger than 1 cm.

A cirurgia micrográfica de Mohs (CMM) é realizada em fases sucessivas de retirada tumoral. Cada fase demora de uma a duas horas, dependendo do tamanho da lesão; portanto, é muito importante conseguir predizer o número de fases da cirurgia a fim de poder programar melhor o tempo de uso da sala cirúrgica e da equipe cirúrgica, o uso de anestésicos, os custos da cirurgia, melhor orientar o paciente e assegurar a remoção completa do tumor. Com o intuito de encontrar fatores preditivos do número de fases da CMM no tratamento do carcinoma espinocelular da cabeça, realizou-se o levantamento dos prontuários de 44 pacientes submetidos a 51 CMM no ambulatório de cirurgia dermatológica da Divisão de Dermatologia do HC-FMUSP/SP, de 1994 a 2003. Foram constituídos três grupos quanto ao número de fases da CMM: uma fase, duas fases e três ou mais fases. Os grupos foram comparados em relação às variáveis: duração da lesão até a cirurgia, morfologia, tamanho e limites da lesão, tumor primário ou recidivado, grau de diferenciação histológica do tumor e localização anatômica do tumor. Identificou-se um único fator significante na análise univariada: a distribuição dos tumores recidivados segundo o número de fases da cirurgia e que diferiu da distribuição dos tumores primários (p=0,081, teste exato de Fisher), sendo maior o número de fases para os tumores recidivados. Na análise multivariada, não houve fatores estatisticamente significantes que pudessem estar associados ao número de fases da cirurgia. Na análise da razão de chances, observou-se maior chance de apresentar maior número de fases para as variáveis: limites clínicos imprecisos, tumor ulcerado, tumor recidivado, tumor mais agressivo histologicamente e tumor maior que 1 cm. / Mohs micrographic surgery (MMS) is proceeded in successive stages of cancer removal. Each stage lasts from 1 to 2 hours, depending on the tumor size. So it is very important to predict the number of phases of the surgery so that one can plan better the time of the surgical room use, the time of the surgeon and his team, the use of anaesthetics, the surgical costs, to give the patient better orientations about his surgery and to ensure complete tumor erradication. With the intention to find predictive factors of the number of stages of MMS in the treatment of squamous cell carcinoma, we reviewed the record of 44 patients on a total of 51 surgeries proceeded in the dermatologic surgical clinic of the Dermatological Division of HC-FMUSP/SP from 1994 to 2003. For the number of stages in the MMS we established 3 groups: 1 stage, 2 stages and 3 or more stages. These groups were compared with regard to this variables: continuance of the lesion until the surgery, morphology and size of the lesion, lesion limits, primary or recurrent cancer, histological grade (Broders) and anatomic localization. In the univariated analysis one single factor was significant: the distribution of the recurrent cancers related to the number of stages of the surgery that was different from the distribution of the primary ones (p=0.081, Fisher\'s exact test), been higher the number of stages for the recurrent cancers. In the multivariated analysis, there were no statistically significant factors associated with higher number of stages of the surgery. In the analysis of the odss ratio, we noted a higher chance of a higher number of stages for the variables: inaccurate clinical limits, ulcerated lesions, recurrent cancer, higher aggressive histology and tumor bigger than 1 cm.

Head and neck cancer is a heterogeneous group of tumours, of which certain subgroups such as cancer of the mobile tongue frequently are associated with a relatively poor prognosis due to the high risk of regional failure and mortality rates that haven’t improved in a significant way over the last 3 decades, despite advancements in both diagnostics and treatment. Today we lack means to assess the biological aggressiveness of each individual tumour, which varies largely. Treatment comprises of surgery with additional radiotherapy and medical therapies in more advanced tumours. The focus in this thesis is on molecular biomarker expression in head and neck cancer and especially in association with radiotherapy. Increased knowledge paves the way to a more individualized cancer treatment aiming for better outcome and less overtreatment and sequelae. The aims of this thesis was: To map the effects of radiotherapy in both tumour and adjacent tissue for the possible markers hyaluronan, EGFR and mast cells. To investigate whether the expression of hyaluronan in the epithelium and connective tissue stroma and EGFR in the tumour correlates with the risk for developing cervical metastasis in N0 patients, and to find out whether the 3-year tumour-specific survival rates correlates with the expression of HA in the epithelium and EGFR in the tumour. To establish an animal model for radiation-induced mucositis and to use that model to examine the pattern of invading inflammatory cells. To investigate whether the expression of podoplanin in tongue cancer correlates with the risk for cervical metastasis and to determine whether the total amount of lymph vessels in the diagnostic biopsy has any impact on the clinical outcome. To investigate the differences in the metabolome of tongue cancer cell lines with different radiosensitivity. The most important findings of this thesis were: The expression of EGFR and hyaluronan hade the same pattern of expression in both tumour and adjacent tissues before radiotherapy. The expression of EGFR was increased in the epithelium of the adjacent tissue close to the tumour after radiotherapy. The intensity of the staining of hyaluronan was correlated to the 3-year survival rates in patients with tongue cancer. An experimental model for radiation-induced oral mucositis in rat was established and in this model a temporal pattern of macrophage invasion with two different subtypes of macrophages was found. There were no correlation between the expression of podoplanin in the tumour tissue and the cervical metastasis rate in patients with tongue cancer, but the younger patients were more likely to have a higher expression of podoplanin in their tumour than elder patients. Tongue cancer cell lines with different radiosensitivity respond to irradiation with different patterns of metabolic expressions.

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No description available.

INTRODUÇÃO: A epidermodisplasia verruciforme (EV) é uma rara genodermatose, associada ao beta-papilomavírus humano (Beta-HPV) e alto risco de desenvolvimento de câncer de pele. As claudinas são proteínas transmembranas expressas nos diversos epitélios e podem se alterar na carcinogênese. Para melhor compreensão do papel do Beta-HPV na carcinogênese cutânea, realizou-se um estudo da expressão das claudinas nos pacientes com e sem EV. MÉTODOS: Um painel de anticorpos anti-claudina -1, -2, -3, -4, -5, -7 e -11 foi empregado para analisar a expressão dessa proteína em 108 amostras de pele normal, 39 verrugas planas e 174 carcinomas espinocelulares cutâneo (CEC), obtidas de 33 pacientes com epidermodisplasia verruciforme (EV) e 112 indivíduos saudáveis (não EV- NEV). As amostras de CEC foram organizadas em 4 microarranjos teciduais. A análise estatística foi realizada por regressão logística para verificar as alterações do perfil de claudinas na carcinogênese e sua relação com idade, sexo e fotoexposição crônica nos doentes com EV e o grupo NEV. RESULTADOS: A expressão focal da claudina-1 apresentou associação com o CEC (p < 0,001) e a expressão não difusa (focal ou negativa) da claudina-2 esteve associado a verruga plana (p < 0,001), nos grupos EV e NEV. A expressão focal da claudina-3 apresentou associação com o CEC (p < 0,001), bem como a imunomarcação nuclear da claudina-3 (p < 0,001), em ambos os grupos. Adicionalmente, a chance da expressão nuclear da claudina-3 foi 53% menor nas áreas não fotoexpostas. A claudina-5 apresentou maiores porcentagens de expressão focal na pele normal, de expressão difusa no CEC e na verruga plana EV, e de expressão negativa na verruga plana NEV. O grupo EV apresentou menor chance de expressão focal e negativa (p < 0,001). Além disso, a negatividade da claudina-5 esteve associada a verruga plana (p < 0,001) e menor média de idade (p < 0,001). As claudinas -4, -7 e -11 apresentaram expressão difusa em quase todas as amostras estudadas, nos grupos EV e NEV. CONCLUSÕES: Verificou-se aumento progressivo da claudina-5 na carcinogênse cutânea e esse processo apresentou relação com a EV. Redução da expressão das claudinas -1 e -3 foi observada nos carcinomas cutâneos, e da claudina-2 nas verrugas planas, no entanto, não puderam ser relacionadas à infecção pelo beta-HPV. Idade e fotoexposição crônica foram fatores que influenciaram a expressão da claudina-5 e a expressão nuclear da claudina-3, respectivamente / BACKGROUND: Epidermodysplasia verruciformis (EV) is a rare genodermatosis, related to human beta-papillomavirus (Beta-HPV), with high risk for developing skin cancer. Claudins are transmembrane proteins expressed in epithelia and may be altered on carcinogenesis. Toward better understanding the role of Beta-HPV in cutaneous carcinogenesis, claudin expression study was performed in lesions of patients with and without EV. METHODS: A panel of anti-claudin antibodies was assembled to analyze claudins -1, -2, -3, -4, -5, -7 and -11 expression, by immunohistochemistry technique, in samples of 108 normal skin, 39 flat warts and 174 cutaneous squamous cell carcinomas (SCC), obtained from 33 patients with EV and 112 individuals without EV (not-EV - NEV). The SCC samples were organized in tissue microarrays. Statistical analysis was performed by logistic regression, aiming to verify changes in claudin profile in carcinogenesis and its relationship with age, sex and chronic sun exposure area, in patients with and without EV. RESULTS: Claudin-1 focal expression was associated with SCC (p < 0.001) and claudin-2 focal or negative expression with flat wart (p < 0.001), in EV and NEV groups. Claudin-3 focal expression was related with SCC (p < 0.001), as well as the nuclear immunostaining of claudin-3 (p < 0.001), in both groups. Additionally, chance of claudin-3 nuclear expression was 53% lower in not sun exposed areas. For claudin-5, focal expression was more common in normal skin, diffuse expression in SCC annd EV flat wart, and negative expression in NEV flat wart. The EV group showed lower chance of focal and negative expression (p < 0.001). In addition, the negativity of claudin-5 expression was associated with flat wart (p < 0.001) and lower mean age (p < 0.001). Claudins -4, -7 and -11 showed, in both groups, diffuse expression in almost all studied samples. CONCLUSIONS: Claudin-5 increasing expression was observed in cutaneous carcinogenesis and this process showed association with EV. Claudin-1 and -3 down expression were observed in cutaneous carcinomas, and claudin-2 in flat warts, however, they could not be related with Beta-HPV infection. Age and chronic sun exposure area were factors that influenced claudin-5 and claudin-3 nuclear expression, respectively