ObjectiveSurvival differences in oral cancer between black and white patients have
been reported, but the contributing factors, especially the role of stage,
are incompletely understood. Furthermore, the outcomes for Hispanic and
Asian patients have been scarcely examined.Study DesignRetrospective, population-based national study.SettingSurveillance, Epidemiology, and End Results 18 Custom database (January 1,
2010, to December 31, 2014).Subjects and MethodsIn total, 7630 patients with primary squamous cell carcinoma in the oral
cavity were classified as non-Hispanic white (white), non-Hispanic black
(black), Hispanic, or Asian. Cox regression was used to obtain unadjusted
and adjusted hazard ratios (HRs) of 5-year mortality for race/ethnicity with
sequential adjustments for stage and other covariates. Logistic regression
was used to examine the relationship between race/ethnicity and stage with
adjusted odds ratios (aORs).ResultsThe cohort consisted of 75.0% whites, 7.6% blacks, 9.1% Hispanics, and 8.3%
Asians. Compared to whites, the unadjusted HR for all-cause mortality for
blacks was 1.68 (P < .001), which attenuated to 1.15
(P = .039) after adjusting for stage and became
insignificant after including insurance. The unadjusted HRs for all-cause
mortality were not significant for Hispanics and Asians vs whites. Compared
to whites, blacks and Hispanics were more likely to present at later stages
(aORs of 2.63 and 1.42, P < .001, respectively).ConclusionThe greater mortality for blacks vs whites was largely attributable to the
higher prevalence of later stages at presentation and being uninsured among
blacks. There was no statistically significant difference in mortality for
Hispanics vs whites or Asians vs whites.
Tumor cell invasion of basement membranes is one of the hallmarks of malignant transformation. Tumor cells secrete proteolytic enzymes known as matrix metalloproteinases (MMPs) which degrade extracellular matrix molecules. Increased expression of MMP-9 has been associated with acquisition of invasive phenotype in many tumors. However, multiple mechanisms for regulation of MMP-9 gene expression by tumor cell lines have been proposed. A number of transcription factor binding sites have been characterized in the upstream regulatory region of the MMP-9 gene, including those for AP-1. To determine how a specific AP-1 family member, c-fos, regulates MMP-9 promoter activity through these sites, we used an expression vector containing the c-fos coding region fused to the estrogen receptor (ER) ligand binding domain. This construct is activated upon binding estradiol. Stable expression of this construct in ER negative squamous cell carcinoma (SCC) lines produced an estradiol dependent decrease in the number of cells that migrated through a reconstituted basement membrane. This decreased invasiveness was accompanied by estradiol dependent downregulation of MMP-9 activity as determined by gelatin zymography. Estradiol also produced transcriptional downregulation of an MMP-9 promoter construct in cells transiently transfected with the c-fosER expression vector. This downregulation was mediated by the AP-1 site at -79 bp in the MMP-9 promoter. We concluded that the proximal AP-1 site mediated the transcriptional downregulation of the MMP-9 promoter by a conditionally activated c-fos fusion protein.
Extranodal presentation of B-cell lymphoma is uncommon. Isolated primary epiglottic B-cell lymphoma is even rarer. To our knowledge, there has been only one description of isolated B-cell lymphoma presenting as a large epiglottic mass. We report an unusual type of B-cell lymphoma of the epiglottis, as it could not be subtyped based on routine staining and hybridization. The lymphoma presented as a large isolated globular mass pedicled to the epiglottis, occupying most of the oropharynx, but did not have any ball-valving effect or increased respiratory efforts. Initial radiographic findings were nonspecific. The diagnosis of B-cell lymphoma was determined by transoral incisional biopsy under local anesthesia. The condition was treated successfully with chemoradiation. The current standard of treatment for high grade B-cell lymphoma is concurrent chemoradiotherapy, with excellent prognosis. Although rare, B-cell lymphoma should be considered when investigating pedunculated hypopharyngeal masses.
Giant cell tumor is a benign but locally aggressive tumor typically found in the long bones but has also been reported in several head and neck locations. Although rare, it can arise from endochondral bone within the larynx, however there have been no prior reported occurrences in the trachea. We report a giant cell tumor of the cricoid cartilage presenting as an endotracheal mass with dysphonia and dyspnea on exertion which was treated with endoscopic excision. The tumor is diagnosed histologically as no clinical or radiographic findings are specific for giant cell tumor. Optimal treatment and recurrence rate is unknown but review of laryngeal lesions suggests complete excision has favorable results. Radiation therapy poses risk for malignant transformation.
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