Tumour-cell-derived complement components C1r and C1s promote growth of cutaneous squamous cell carcinoma

Background

The incidence of epidermal keratinocyte‐derived cutaneous squamous cell carcinoma (cSCC) is increasing worldwide.

Objectives

To study the role of the complement classical pathway components C1q, C1r and C1s in the progression of cSCC.

Methods

The mRNA levels of C1Q subunits and C1R and C1S in cSCC cell lines, normal human epidermal keratinocytes, cSCC tumours in vivo and normal skin were analysed with quantitative real‐time polymerase chain reaction. The production of C1r and C1s was determined with Western blotting. The expression of C1r and C1s in tissue samples in vivo was analysed with immunohistochemistry and further investigated in human cSCC xenografts by knocking down C1r and C1s.

Results

Significantly elevated C1R and C1S mRNA levels and production of C1r and C1s were detected in cSCC cells, compared with normal human epidermal keratinocytes. The mRNA levels of C1R and C1S were markedly elevated in cSCC tumours in vivo compared with normal skin. Abundant expression of C1r and C1s by tumour cells was detected in invasive sporadic cSCCs and recessive dystrophic epidermolysis bullosa‐associated cSCCs, whereas the expression of C1r and C1s was lower in cSCC in situ, actinic keratosis and normal skin. Knockdown of C1r and C1s expression in cSCC cells inhibited activation of extracellular signal‐related kinase 1/2 and Akt, promoted apoptosis of cSCC cells and significantly suppressed growth and vascularization of human cSCC xenograft tumours in vivo.

Conclusions

These results provide evidence for the role of tumour‐cell‐derived C1r and C1s in the progression of cSCC and identify them as biomarkers and putative therapeutic targets in cSCC.

What's already known about this topic?

The incidences of actinic keratosis, cutaneous squamous cell carcinoma (cSCC) in situ and invasive cSCC are increasing globally.

Few specific biomarkers for progression of cSCC have been identified, and no biological markers are in clinical use to predict the aggressiveness of actinic keratosis, cSCC in situ and invasive cSCC.

What does this study add?

Our results provide novel evidence for the role of complement classical pathway components C1r and C1s in the progression of cSCC.

What is the translational message?

Our results identify complement classical pathway components C1r and C1s as biomarkers and putative therapeutic targets in cSCC.

Linked Comment: https://doi.org/10.1111/bjd.18419.

https://doi.org/10.1111/bjd.18821 available online

Abstract 5214: Tumor cell-derived complement components C1r and C1s promote growth of cutaneous squamous cell carcinoma

The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing worldwide. We have analyzed the role of complement components C1r and C1s in the progression of cSCC. Analysis of cSCC cell lines (n=8) and normal human epidermal keratinocytes (NHEK)(n=11) with oligonucleotide arrays, RNA-seq and quantitative RT-PCR revealed significantly elevated C1r and C1s mRNA levels in cSCC cell lines. Western blot analysis showed increased production of C1r and C1s in cSCC cells compared to NHEKs. The mRNA levels for C1r and C1s were markedly elevated in cSCC tumors (n=6) compared to normal skin (n=11) in vivo. Immunohistochemical analysis for C1r and C1s revealed strong tumor cell specific expression of C1r and C1s in invasive sporadic cSCCs (n=164) and recessive dystrophic epidermolysis bullosa-associated cSCCs (n=16), whereas the expression of both was clearly lower in cSCC in situ (n=63), in premalignant epidermal lesions (actinic keratoses, n=61), and in normal skin (n=9). Knockdown of C1r and C1s expression with two specific siRNAs inhibited proliferation of cSCC cells and growth of human cSCC xenograft tumors in vivo. These results provide evidence for the role of tumor cell-derived C1r and C1s in the progression of cSCC independently of C1q and identify these serine proteinases as putative therapeutic targets in unresectable and metastatic cSCC.

Citation Format: Pilvi Riihilä, Liisa Nissinen, Mehdi Farshchian, Markku Kallajoki, Atte Kivisaari, Seppo Meri, Reidar Grénman, Sirkku Peltonen, Juha Peltonen, Veli-Matti Kähäri. Tumor cell-derived complement components C1r and C1s promote growth of cutaneous squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5214.

Tumor cell-specific AIM2 regulates growth and invasion of cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer. Inflammation is a typical feature in cSCC progression. Analysis of the expression of inflammasome components in cSCC cell lines and normal human epidermal keratinocytes revealed upregulation of the expression of AIM2 mRNA and protein in cSCC cells. Elevated levels of AIM2 mRNA were noted in cSCCs in vivo compared with normal skin. Strong and moderate tumor cell specific expression of AIM2 was detected with immunohistochemistry (IHC) in sporadic human cSCCs in vivo, whereas expression of AIM2 was moderate in cSCC in situ (cSCCIS) and low or absent in actinic keratosis (AK) and normal skin. IHC of cSCCs, cSCCIS and AKs from organ transplant recipients also revealed strong and moderate tumor cell specific expression of AIM2 in cSCCs. Knockdown of AIM2 resulted in reduction in viability of cSCC cells and onset of apoptosis. RNA-seq and pathway analysis after knockdown of AIM2 in cSCC cells revealed downregulation of the biofunction category Cell cycle and upregulation of the biofunction category Cell Death and Survival. Knockdown of AIM2 also resulted in reduction in invasion of cSCC cells and downregulation in production of invasion proteinases MMP1 and MMP13. Knockdown of AIM2 resulted in suppression of growth and vascularization of cSCC xenografts in vivo. These results provide evidence for the role of AIM2 in the progression of cSCC and identify AIM2 inflammasome function as a potential therapeutic target in these invasive and metastatic tumors.

Expression of claudin-11 by tumor cells in cutaneous squamous cell carcinoma is dependent on the activity of p38δ

The incidence of cutaneous squamous cell carcinoma (cSCC) is rapidly increasing, and the prognosis of patients with metastatic disease is poor. There is an emerging need to identify molecular markers for predicting aggressive behaviour of cSCC. Here, we have examined the role of tight junction (TJ) components in the progression of cSCC. The expression pattern of mRNAs for TJ components was determined with RNA sequencing and oligonucleotide array-based expression analysis from cSCC cell lines (n=8) and normal human epidermal keratinocytes (NHEK, n=5). The expression of CLDN11 was specifically elevated in primary cSCC cell lines (n=5), but low or absent in metastatic cSCC cell lines (n=3) and NHEKs. Claudin-11 was detected in cell-cell contacts of primary cSCC cells in culture by indirect immunofluorescence analysis. Analysis of a large panel of tissue samples from sporadic UV-induced cSCC (n=65), cSCC in situ (n=56), actinic keratoses (n=31), seborrhoeic keratoses (n=7) and normal skin (n=16) by immunohistochemistry showed specific staining for claudin-11 in intercellular junctions of keratinizing tumor cells in well and moderately differentiated cSCCs, whereas no staining for claudin-11 was detected in poorly differentiated tumors. The expression of claudin-11 in cSCC cells was dependent on the activity of p38δ MAPK and knock-down of claudin-11 enhanced cSCC cell invasion. These findings provide evidence for the role of claudin-11 in regulation of cSCC invasion and suggest loss of claudin-11 expression in tumor cells as a biomarker for advanced stage of cSCC.

Complement Component C3 and Complement Factor B Promote Growth of Cutaneous Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma (cSCC) is one of the most common metastatic skin cancers with increasing incidence. We examined the roles of complement component C3 and complement factor B (CFB) in the growth of cSCC. Analysis of cSCC cell lines (n = 8) and normal human epidermal keratinocytes (n = 11) with real-time quantitative PCR and Western blotting revealed up-regulation of C3 and CFB expression in cSCC cells. Immunohistochemical staining revealed stronger tumor cell-specific labeling for C3 and CFB in invasive cSCCs (n = 71) and recessive dystrophic epidermolysis bullosa-associated cSCCs (n = 11) than in cSCC in situ (n = 69), actinic keratoses (n = 63), and normal skin (n = 5). Significant up-regulation of C3 and CFB mRNA expression was noted in chemically induced mouse cSCCs, compared to benign papillomas. Knockdown of C3 and CFB expression inhibited migration and proliferation of cSCC cells and resulted in potent inhibition of extracellular signal-regulated kinase 1/2 activation. Knockdown of C3 and CFB markedly inhibited growth of human cSCC xenograft tumors in vivo. These results provide evidence for the roles of C3 and CFB in the development of cSCC and identify them as biomarkers and potential therapeutic targets in this metastatic skin cancer.

MR imaging in chronic rupture of the ulnar collateral ligament of the thumb

Purpose: MR imaging has been shown as the best radiologic method for verifying and classifying acute ulnar collateral ligament (UCL) ruptures of the thumb. Our aim was to analyse the usefulness of MR also in old ruptures and to establish the most useful sequences.

Material and Methods: Ten patients with an old UCL rupture of the thumb were preoperatively imaged using 1.5 T MR. Three radiologists blinded to the findings separately analysed the MR images of these patients and of 10 age-and sex-matched voluntary controls. MR findings of the patients were compared with those of surgery.

Results: The consensus diagnosis of an UCL rupture was accurate in all 10 patients. All controls were classified as having no UCL rupture. In 5 of the 7 patients with a surgically defined Stener or non-Stener lesion, the consensus diagnosis was the same as the operative diagnosis. Due to excessive scarring it was not possible to verify any Stener lesion intra-operatively in 3 patients. The most informative MR sequence was T2 TSE in the coronal plane, the second most informative was T1 SE with fat suppression in the coronal plane.

Conclusion: An old UCL rupture is well verified by MR but typing of the lesion as either a Stener or non-Stener type is not always possible.

Detection of Soft-Tissue and Skeletal Infections with Ultra Low-Field (0.02 T) Mr Imaging

To evaluate the use of ultra low-field (0.02 T) magnetic resonance (MR) imaging in the diagnosis of musculoskeletal infection, MR examinations with T2 weighted sequences were performed in 61 patients thought to be suffering from one of four major diagnostic categories: Soft-tissue abscesses (n=22), osteomyelitis (n=21), septic arthritis (n=9) and spondylitis (n=9). Infection was confirmed for 37 of these 61 patients. The verified abscesses, arthritis, spondylitis and acute osteomyelitis could be detected by 0.02 T MR. The sensitivity was poor in cases of chronic osteomyelitis. There was one false positive finding in a patient with a possible soft tissue infection. The 0.02 T MR examination failed four times. Two patients were too heavy and another 2 patients had magnetic material in or near the scanning field. Compared with computed tomography and isotope scanning, 0.02 T MR proved a little more informative, but without any statistical significance.

Improvement of Bedside Chest Radiograph Quality Using a High Ratio Grid and an Electronic Angle Meter for Alignment

An electronic level was used to ensure proper alignment of a high ratio grid at bedside chest radiography. The image quality was clearly improved. The method is inexpensive and simple to use.

Evaluation of pleural disease using MR and CT: With special reference to malignant pleural mesothelioma

Purpose: To evaluate MR imaging and CT in differentiating malignant pleural mesothelioma from other malignancies or benign pleural disease.

Material and Methods: Thirty-four patients (18 pleural mesotheliomas, 9 other malignancies, 7 benign pleural diseases) were examined using enhanced CT and MR. Two radiologists reviewed the CT and two others the MR images. Comparisons were made between the diagnostic groups and the imaging methods.

Results: The abnormalities commonly found in malignant disease, but significantly less frequently in benign pleural disease, were focal thickening and enhancement of interlobar fissures. In mesothelioma, enhancement of interlobar fissures, tumour invasion of the diaphragm, mediastinal soft tissue or chest wall, were significantly more often observed than in other malignancies and MR was the most sensitive method. In other malignancies, invasion of bony structures was a more common finding and was also better shown by MR. The contrast-enhanced T1 fat-suppressed (CET1fs) sequence detected these features better than other MR sequences.

Conclusion: MR, especially the CET1fs sequence in three planes, gave more information than enhanced CT. Focal thickening and enhancement of interlobar fissures were early abnormalities indicating malignant pleural disease. MR could be clinically useful for differentiating mesothelioma from other pleural diseases.

Abstract 982: Long non-coding RNA PICSAR promotes growth of cutaneous squamous cell carcinoma by regulating ERK1/2 activity

Keratinocyte-derived cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer, and its incidence is increasing globally. Long non-coding RNAs (lncRNAs) are involved in various biological processes, and their role in cancer progression is emerging. The aim of this study was to find and characterize new biomarkers for evaluating the risk of progression and metastasis of cSCC and identify novel therapeutic targets for recurrent and metastatic cSCC. RNA-sequencing of cSCC cells (n = 8) and normal human epidermal keratinocytes (NHEKs, n = 4) revealed overexpression of a previously uncharacterized long intergenic non-coding RNA (lincRNA), LINC00162 in cSCC cells. Analysis of tissue sections by RNA in situ hybridization showed that LINC00162 is specifically expressed by tumor cells in cSCCs but not by keratinocytes in normal skin in vivo. The expression of LINC00162 in cSCC cells was upregulated by inhibition of the p38α and p38δ MAPKs using BIRB796 or p38α and p38δ specific siRNAs. Knockdown of LINC00162 inhibited proliferation and migration of cSCC cells, and suppressed the growth of human cSCC xenografts in vivo. Furthermore, knockdown of LINC00162 inhibited ERK1/2 activity and upregulated expression of dual specificity phosphatase DUSP6 in cSCC cells. Based on these observations, LINC00162 was named PICSAR (P38 Inhibited Cutaneous Squamous cell carcinoma Associated lincRNA). Our results provide mechanistic evidence for the role of PICSAR in promoting cSCC progression via activation of ERK1/2 signaling pathway by downregulating DUSP6 expression. These results also identify PICSAR as a novel biomarker and putative therapeutic target in cSCC.

Citation Format: Minna Piipponen, Liisa Nissinen, Mehdi Farshchian, Pilvi Riihilä, Atte Kivisaari, Markku Kallajoki, Juha Peltonen, Sirkku Peltonen, Veli-Matti Kähäri. Long non-coding RNA PICSAR promotes growth of cutaneous squamous cell carcinoma by regulating ERK1/2 activity. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 982.

Suppression of TGFβ and Angiogenesis by Type VII Collagen in Cutaneous SCC

BACKGROUND

Individuals with severe generalized recessive dystrophic epidermolysis bullosa (RDEB), an inherited blistering disorder caused by mutations in the COL7A1 gene, develop unexplained aggressive squamous cell carcinomas (SCC). Here we report that loss of type VII collagen (Col7) in SCC results in increased TGFβ signaling and angiogenesis in vitro and in vivo.

METHODS

Stable knockdown (KD) of Col7 was established using shRNA, and cells were used in a mouse xenograft model. Angiogenesis was assessed by immunohistochemistry, endothelial tube-forming assays, and proteome arrays. Mouse and zebrafish models were used to examine the effect of recombinant Col7 on angiogenesis. Findings were confirmed in anonymized, archival human tissue: RDEB SCC tumors, non-EB SCC tumors, RDEB skin, normal skin; and two human RDEB SCC cell lines. The TGFβ pathway was examined using immunoblotting, immunohistochemistry, biochemical inhibition, and siRNA. All statistical tests were two-sided.

RESULTS

Increased numbers of cross-cut blood vessels were observed in Col7 KD compared with control xenografts (n = 4 to 7 per group) and in RDEB tumors (n = 21) compared with sporadic SCC (n = 24, P < .001). Recombinant human Col7 reversed the increased SCC angiogenesis in Col7 KD xenografts in vivo (n = 7 per group, P = .04). Blocking the interaction between α2β1 integrin and Col7 increased TGFB1 mRNA expression 1.8-fold and p-Smad2 levels two-fold. Increased TGFβ signaling and VEGF expression were observed in Col7 KD xenografts (n = 4) compared with control (n = 4) and RDEB tumors (TGFβ markers, n = 6; VEGF, n = 17) compared with sporadic SCC (TGFβ markers, n = 6; VEGF, n = 21). Inhibition of TGFβ receptor signaling using siRNA resulted in decreased endothelial cell tube formation (n = 9 per group, mean tubes per well siC = 63.6, SD = 17.1; mean tubes per well siTβRII = 29.7, SD = 6.1, P = .02).

CONCLUSIONS

Type VII collagen suppresses TGFβ signaling and angiogenesis in cutaneous SCC. Patients with RDEB SCC may benefit from anti-angiogenic therapy.

Abstract 3201: Complement component C3 and complement factor B regulate growth of cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer and its incidence is increasing globally. We have examined the role of complement component C3 and complement factor B (CFB) in the progression of cSCC. Significantly elevated mRNA levels for C3 and CFB were detected din cSCC cell lines (n = 8) compared to normal human epidermal keratinocytes (n = 11) by quantitative real-time reverse transcriptase-PCR. Increased production of C3 and CFB by cSCC cell lines was detected by western blotting. The mRNA levels for C3 and CFB were also markedly higher in cSCC tumors (n = 6) than in normal skin (n = 10). Tumor cell specific staining for C3 and CFB was detected in cSCC tumors in vivo by immunohistochemistry and the staining intensity was stronger in invasive cSCCs (n = 71) than in cSCC in situ (n = 69), premalignant epidermal lesions (actinic keratoses, n = 65) and normal skin (n = 5). Significant upregulation of C3 and CFB mRNA expression was also noted in chemically induced mouse skin cSCCs (n = 27) compared to benign papillomas (n = 17). The expression of C3 and CFB at mRNA and protein level was markedly higher in invasive tumorigenic Ha-ras-transformed HaCaT cell line than in benign tumorigenic ras-transformed HaCaT cells and parental non-tumorigenic HaCaT cells. The expression of both C3 and CFB was significantly upregulated by IFN-γ and TNF-α in cSCC cells. Knockdown of CFB and C3 by specific siRNAs inhibited migration of cSCC cells. Knockdown of CFB inhibited proliferation of cSCC cells and this was associated with potent inhibition of ERK1/2 activation. Knockdown of C3 and CFB also significantly inhibited growth of human cSCC xenograft tumors in vivo in SCID mice. These results provide evidence for the role of C3 and CFB in progression of cSCC and identify them as specific biomarkers and putative therapeutic targets for invasive cSCC.

Citation Format: Pilvi Riihila, Mehdi Farshchian, Markku Kallajoki, Atte Kivisaari, Seppo Meri, Reidar Grenman, Ritva Heljasvaara, Taina Pihlajaniemi, Juha Peltonen, Sirkku Peltonen, Veli-Matti Kahari. Complement component C3 and complement factor B regulate growth of cutaneous squamous cell carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3201. doi:10.1158/1538-7445.AM2015-3201

Squamous cell carcinoma of the skin: Emerging need for novel biomarkers

The incidence of non-melanoma skin cancers (NMSC) is rising worldwide resulting in demand for clinically useful prognostic biomarkers for these malignant tumors, especially for invasive and metastatic cutaneous squamous cell carcinoma (cSCC). Important risk factors for the development and progression of cSCC include ultraviolet radiation, chronic skin ulcers and immunosuppression. Due to the role of cumulative long-term sun exposure, cSCC is usually a disease of the elderly, but the incidence is also growing in younger individuals due to increased recreational exposure to sunlight. Although clinical diagnosis of cSCC is usually easy and treatment with surgical excision curable, it is responsible for the majority of NMSC related deaths. Clinicians treating skin cancer patients are aware that certain cSCCs grow rapidly and metastasize, but the underlying molecular mechanisms responsible for the aggressive progression of a subpopulation of cSCCs remain incompletely understood. Recently, new molecular markers for progression of cSCC have been identified.

Serpin peptidase inhibitor clade A member 1 (SerpinA1) is a novel biomarker for progression of cutaneous squamous cell carcinoma

The incidence of keratinocyte-derived nonmelanoma skin cancers is increasing worldwide because of cumulative recreational exposure to sunlight. At present, no specific molecular markers are available for assessing the progression of premalignant actinic keratoses to invasive cutaneous squamous cell carcinoma (SCC). We examined the role of the Serpin family in skin SCCs. Expression profiling of cutaneous SCC cell lines (n = 8) revealed up-regulation of SerpinA1 compared with normal epidermal keratinocytes (n = 5). Analysis with quantitative RT-PCR showed that the mean level of SerpinA1 mRNA was markedly up-regulated in cutaneous SCC cell lines (n = 8) compared with in normal keratinocytes. SerpinA1 production by SCC cells was dependent on p38 mitogen-activated protein kinase activity and was up-regulated by epidermal growth factor, tumor necrosis factor-α, interferon-γ, and IL-1β. Immunostaining of tissue arrays with 148 human tissue samples revealed tumor cell-associated expression of SerpinA1 in 19 of 36 actinic keratoses, 22 of 29 Bowen's disease samples, 67 of 71 sporadic SCCs, and all 12 recessive dystrophic epidermolysis bullosa-associated SCCs examined. Moreover, tumor cell-associated SerpinA1 staining was detected in all chemically induced mouse skin SCCs studied (n = 17). Overexpression of SerpinA1 mRNA was also detected by quantitative RT-PCR in chemically induced mouse skin SCCs (n = 14) compared with control tissues (n = 14). These data identify SerpinA1 as a novel tumor cell-associated biomarker for progression of cutaneous SCCs.

Cutaneous lupus erythematosus after treatment with paclitaxel and bevacizumab for metastatic breast cancer: a case report

Introduction

The monoclonal anti-vascular endothelial growth factor antibody bevacizumab is increasingly used in the treatment of several malignant tumors. The usual side effects of this drug are hypertension and proteinuria. Paclitaxel is widely used in the treatment of breast cancer and head and neck carcinomas. Neither of these two drugs typically causes skin disorders. Paclitaxel-related cutaneous lupus erythematosus has been described before, but in earlier cases patients had a history of autoimmune disease.

Case presentation

We report a case of a 65-year-old Caucasian woman who presented with cutaneous lupus erythematosus after receiving paclitaxel-bevacizumab combination treatment as first-line therapy for metastatic breast cancer. Her cutaneous symptoms and increased serum anti-SSA and anti-SSB antibodies disappeared shortly after the discontinuation of therapy.

Conclusion

We conclude that cutaneous lupus erythematosus can also be seen in patients without earlier anamnesis of autoimmune disorders and that, furthermore, bevacizumab might cause atypical cutaneous side effects.

Matrix metalloproteinase (MMP)-7 in salivary gland cancer

INTRODUCTION

High levels of certain matrix metalloproteinases (MMPs) have been detected in various human cancers. The purpose of this study was to analyze the expression of MMP-7 in salivary gland cancer (SGC) by immunohistochemistry and to associate the results with the clinical data and the 10-year survival of the SGC patients.

MATERIAL AND METHODS

Immunohistochemistry for MMP-7 was performed in a series of 107 paraffin-embedded sections of SGC. The samples represent the entire SGC population in Finland from 1991-1996. Mortality follow-up ended December 31, 2006.

RESULTS

The study population of 107 patients consisted of 47 male and 60 female subjects, ranging in age at the time of diagnosis between 23 and 90 years. The minimum follow-up time was 10.6 years and the maximum 15.9 years. By age-adjusted analysis lower staining intensity was associated with worse overall survival of patients with acinic cell carcinoma (p = 0.047, HR 6.5, 95% Cl 1.0-41.7) and in mucoepidermoid carcinoma (p = 0.010, HR 9.3, 95% CI 1.7-50.0). Low staining intensity was also associated with worse disease-specific survival of patients with acinic cell carcinoma (0-1 vs. 2-3; p = 0.047, HR 13.7, 1.0-200.0). VCI Ki-67 was an important prognostic factor for survival of the entire data set (p < 0.0001, HR 4.7, 95% Cl 2.3-9.8).

CONCLUSIONS

MMP-7 is associated with the prognosis of patients with acinic cell and mucoepidermoid carcinoma.

Matrix metalloproteinase (MMP)-1, -9 and -13 as prognostic factors in salivary gland cancer

CONCLUSIONS

In the current study matrix metalloproteinases (MMPs)-9 and -13 were associated with the prognosis in salivary gland cancer (SGC), indicating that they contribute to the progression and invasion of these malignant tumours.

OBJECTIVES

Elevated levels of certain MMPs have been detected in various advanced human cancer types. The purpose of the study was to analyse the expression of MMP-1, -9 and -13 in SGC by immunohistochemistry and correlate the results to the clinical data and 10-year survival of SGC patients in a nationwide material.

MATERIALS AND METHODS

Immunohistochemistry for MMP-1, -9 and -13 was performed in series of 103 paraffin-embedded sections of SGC.

RESULTS

High MMP-13 staining intensity predicted poor survival (3 vs 1; p=0.08) in the whole material studied. High MMP-13 intensity (2+3 vs 1; p=0.05), percentage (2 vs 1; p=0.03) and index (3 vs 1; p=0.02) were associated with poor survival in acinic cell carcinoma. However, high MMP-9 index in adenoid cystic carcinoma (p=0.06) and the percentage of positively staining cells in salivary duct carcinoma patients (p=0.05) was associated with poor survival. High MMP-1 staining intensity (2 vs 0; p=0.06) and index (% x intensity); (2 vs 1, p=0.04) were associated with better overall survival in the whole material.

Intra-abdominal abscess in a patient with tumour necrosis factor receptor-associated periodic syndrome

Tumour necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is an autoinflammatory disorder characterized by periodic attacks of fever and inflammation, due to mutations in the gene coding for the TNF type I receptor (TNFRSF1A). A 16-year-old patient with the diagnosis of TRAPS was admitted to hospital because of fever and abdominal pain. Initially, the symptoms were interpreted as manifestations of another TRAPS attack, but the patient's condition worsened, despite treatment with corticosteroids and antibiotics. A repeated computer tomography revealed an intra-abdominal abscess, which necessitated urgent surgical intervention. This case stresses the importance of differential diagnostic vigilance when dealing with patients with rare genetic diseases.

Acute paediatric ankle trauma: MRI versus plain radiography

OBJECTIVE

To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard.

METHODS

Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three "masked" radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI.

RESULTS

Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures, Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter-Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury.

CONCLUSIONS

The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries.

MRI abnormalities of foot and ankle in asymptomatic, physically active individuals

OBJECTIVE

To assess MRI changes in the ankle and foot after physical exercise.

DESIGN AND PATIENTS

Nineteen non-professional marathon runners and 19 age- and sex-matched controls volunteered for the study. All had ankle and foot MR images (1.5 T) taken in three perpendicular planes (STIR, T2F and T1FS sequences) within 3 h of running a full-length marathon (42.125 km). Three radiologists independently analysed the groups on a masked basis using a predefined form.

RESULTS

Severe bone marrow oedema was seen in one and slight bone marrow oedema in three marathon runners. Slight bone marrow oedema was found in three control subjects. Signal alteration within the soleus muscle, consistent with a grade 1 strain, was found in one marathon runner. Small punctate hyperintensities within the Achilles tendon were seen in 26% of the marathon runners and in 63% of controls (P = 0.016). An increased amount of fluid in the retrocalcaneal bursa was found in one control and in none of the marathon runners. Small amounts of fluid in the retrocalcaneal bursa were seen in 68% of marathon runners and in 53% of controls. Grade 1 or 2 peritendinous joint fluid was found around 22% of tendons, among both marathon runners and controls, most often involving the tendon sheath of the flexor hallucis longus muscle. An increased amount of joint fluid was noted in 34% of the joints of the marathon runners, and in 18% of the controls.

CONCLUSION

MRI shows several abnormalities in the ankle and foot both after marathon races and in asymptomatic physically active individuals without any preceding extraordinary strain. Recreational sports may lead to a number of positive MRI findings without correlation with clinical findings.

MR imaging in chronic rupture of the ulnar collateral ligament of the thumb

PURPOSE

MR imaging has been shown as the best radiologic method for verifying and classifying acute ulnar collateral ligament (UCL) ruptures of the thumb. Our aim was to analyse the usefulness of MR also in old ruptures and to establish the most useful sequences.

MATERIAL AND METHODS

Ten patients with an old UCL rupture of the thumb were preoperatively imaged using 1.5 T MR. Three radiologists blinded to the findings separately analysed the MR images of these patients and of 10 age-and sex-matched voluntary controls. MR findings of the patients were compared with those of surgery.

RESULTS

The consensus diagnosis of an UCL rupture was accurate in all 10 patients. All controls were classified as having no UCL rupture. In 5 of the 7 patients with a surgically defined Stener or non-Stener lesion, the consensus diagnosis was the same as the operative diagnosis. Due to excessive scarring it was not possible to verify any Stener lesion intra-operatively in 3 patients. The most informative MR sequence was T2 TSE in the coronal plane, the second most informative was T1 SE with fat suppression in the coronal plane.

CONCLUSION

An old UCL rupture is well verified by MR but typing of the lesion as either a Stener or non-Stener type is not always possible.

MR imaging in suspected acute trauma of wrist bones

OBJECTIVE

The purpose of this study was to evaluate the findings of MR imaging compared to plain radiography in acute wrist trauma.

METHODS

Radiography and MR imaging (obtained at 1.5 T) of 67 patients (38 female, 29 male, aged 15-80 years) were analysed by three senior radiologists in a blinded random fashion.

RESULTS

One-third (n= 13) of the 37 fractures observed on MR images were missed on the radiographs. The McNemar test indicated significant differences in diagnoses between radiography and MR.

CONCLUSION

We recommend that MR imaging should be considered in the diagnosis of acute wrist trauma when: 1) There is a clear discrepancy between the clinical status and a negative radiography and when splint treatment would increase cost by causing occupational restrictions; and 2) Healing of trauma diagnosed as contusion or distension does not occur within the expected time.

MR imaging in biofix-osteosynthesis

PURPOSE

Osteosynthesis by means of bioresorbable implants, mostly of self-reinforced poly-L-lactide (SR-PLLA), has been used in humans for about 10 years. The aim of this study was to examine the controversy between histological studies confirming fragmentation of the biomaterial and radiological studies showing no breaking of the material.

MATERIAL AND METHODS

Six patients with displaced malleolar fractures operatively treated with biodegradable SR-PLLA screws underwent MR examinations at 1.5 T, immediately postoperatively and after one to two years.

RESULTS

The biodegradable osteosynthetic screws were clearly seen on all MR images. Of 12 screws, 6 were broken at the final examination (5 syndesmotic transfixation screws and 1 screw through the growth cartilage).

CONCLUSION

The breaking of a biodegradable osteosynthesis is possible to document on MR images.

The clinical importance of magnetic resonance imaging versus computed tomography in malignant pleural mesothelioma

There is no standard therapy for malignant pleural mesothelioma (MPM), but recent reports have shown that extensive surgery combined with chemo- and radiotherapy prolongs the survival of selected patients with early stage disease. This emphasises the need for accurate staging procedures at diagnosis and reliable imaging methods to assess response to treatment. Computed tomography (CT) of the chest has been the standard imaging method for these purposes for the last decade, but it is limited in its ability to demonstrate accurately the platelike growth pattern of MPM within the thorax due to the partial volume effect on curved surfaces. In order to define the value of magnetic resonance imaging (MRI) in the imaging of MPM, we have compared the findings from 26 parallel paired CT and MRI scans of mesothelioma patients at various stages of the disease. MRI showed tumour spread into the interlobar fissures, tumour invasion of the diaphragm and through the diaphragm, and invasion of bony structures better than CT. Invasion of the chest wall and mediastinal soft tissue and tumour growth into the lung parenchyma were equally well seen on both imaging methods. CT was better for detecting the inactive pleural calcifications. MRI is a sensitive detector of the characteristic growth pattern and extension of MPM and we recommend its use more widely for the clinical management of MPM especially when evaluating tumour resectability and in research protocols when an accurate evaluation of disease extent is essential.

Five-year study of medical or surgical treatment in children with severe vesico-ureteral reflux dimercaptosuccinic acid findings. International Reflux Study Group in Europe

The results of serial dimercaptosuccinic acid (DMSA) imaging over 5 years are reported in 287 children with severe vesico-ureteral reflux entered into the European Branch of the International Reflux Study in Children. The children were randomly allocated to medical (n=147) or surgical (n=140) management and DMSA studies were performed during the follow up period at least 6 months after any urinary tract infection. Abnormal images were classified into four types: (1) large polar hypodensity with normal renal outline; (2) peripheral photon deficient defect(s) in a non-deformed kidney; (3) small renal image with normal contour; and (4) peripheral defect(s) with resultant irregularity of the renal outline. The DMSA findings were abnormal at entry in 235 (82%) with no difference in incidence or severity between the two treatment groups. During follow up, deterioration was observed in 25 medically and 23 surgically treated patients and comprised image deterioration alone in 17, image deterioration with corresponding reduction in differential function in 16 and reduction in relative function without image change in 15, with similar distribution between the two treatment groups. Deterioration was more frequent in children entering the study under the age of 2 years and in those with grade IV rather than grade III reflux. These findings, showing no difference in outcome between children managed surgically or medically, are consistent with the radiological results already published.

CONCLUSION

In the International Reflux Study the DMSA scintigraphic data showed no difference in outcome between children managed surgically or medically.

Renal function remains after unilateral total and contralateral partial nephrectomy: an experimental study in pigs using 99mTc-DTPA

Twelve nephrectomies (NEs) were performed in 12 pigs (11-17 kg). Total NE was performed on the left side and partial NE on the right side (lower third of the kidney), thus two-thirds of the total kidney volume was removed. Renal function was studied with 99mTc-diethylenetriaminepentaacetic acid (DTPA) renography and serum urea and creatinine levels preoperatively, and 1 and 2 weeks postoperatively. The pigs were imaged in each session for 30 min by collecting 10-s frames from a posteroanterior (PA) view of an anaesthesized animal. The injected activity was 37 MBq. Serial blood samples were taken from the subclavian vein at 0, 1, 2, 3, 5, 15, 25, 40, 60 and 120 min (six animals) after 99mTc-DTPA injection. The DTPA disappearance rate (DDR) was determined from these samples and in other cases (six animals) a blood sample at 20 min was used. The DDR was also determined from the dynamic gamma imaging data: Regions of interest (ROI) were upper body, spleen, heart and kidneys. The ROI analysis correlated well with the blood sampling data (r = 0.97, P < 0.0001). The reference values for pig DDRs were 0.99 +/- 0.08%/min. These values were 0.71 +/- 0.08%/min at 1 week postoperatively and 0.63 +/- 0.08%/min at 2 weeks. DTPA clearance rates were preoperatively 0.53 +/- 0.06 ml/s; at 1 week postoperatively 0.41 +/- 0.06 ml/s; and at 2 weeks 0.35 +/- 0.06 ml/s. There were no significant differences pre- and postoperatively in creatinine and urea concentrations. The DTPA clearance (ml/s) and disappearance rates (%/min) when determined per kidney area (cm2) increased significantly (P < 0.001 at both 1 and 2 weeks); in 11 of 12 animals the function of the resected right kidney was higher than the split function of the whole right kidney preoperatively. Unilateral nephrectomy initiates a functional adaptation or a growth response in the contralateral kidney to compensate for the loss of a renal mass. These data also indicate that two-thirds of the kidney volume in young pigs can be removed without danger.

Improvement of bedside chest radiograph quality using a high ratio grid and an electronic angle meter for alignment

An electronic level was used to ensure proper alignment of a high ratio grid at bedside chest radiography. The image quality was clearly improved. The method is inexpensive and simple to use.

Effect of digital edge-enhancement on the visibility of normal parenchymal lung markings

Digital 'conventional-like' (C-L) and edge-enhanced (E-E) posteroanterior chest roentgenograms of 42 healthy individuals were ranked twice (interval of at least 5 days) in the order of increasing lung parenchymal markings (a total of four rankings). This was done by three radiologists, two residents, one medical student and one radiographer. There was a good general consistency of rankings for both the C-L and E-E images. The correlation coefficients were best (median 0.600) (P < 0.05) between the consequent rankings of C-L images compared to the subsequent rankings of E-E images (median 0.440) and to the various combinations between the rankings of both kinds of images. Subtle differences in normal lung parenchyma could, therefore, generally (five of the seven observers) best be demonstrated in C-L images, but two observers managed best with the E-E images.

Observed lung markings in normal chest roentgenograms

The digital chest posterior-anterior roentgenograms of 42 healthy individuals were ranked twice (interval of at least 5 days) in the order of increasing lung parenchymal markings. The evaluations were made by three radiologists, two residents, a medical student and a radiographer. All observers regardless of their radiological experience showed good intraobserver correlations between their two subsequent rankings (p < 0.05-0.001). The interobserver agreement on rankings was generally poor, even if the radiologists were considered. Radiologic training seemed to eliminate the influence of false leading factors (the object's respiration and body constitution). "The golden standard of evaluation" (= the added-up rankings by the radiologists) did not correlate either with the patient's ages (19-54 years) or smoking habits (0-45 pack-years, mean 4.2).

Renal function after partial nephrectomy with the Nd-YAG laser. Experimental study in piglets

Twelve partial nephrectomies were performed in 12 piglets using either the combination (contact and non-contact) Nd:YAG laser technique or a steel scalpel. Additional haemostasis was attempted with ligatures. The renal artery was not clamped and renal cooling was not attempted. Total nephrectomy was performed on the contralateral side. Serum creatinine and urea levels were measured, and 99mTc-DTPA renography was performed pre-operatively and 1 and 2 weeks post-operatively. One week post-operatively the mean serum creatinine level was 35% higher than the pre-operative level in the laser group and 30% higher in the steel scalpel group. Two weeks post-operatively the respective differences were 34 and 24%. The mean urea level 1 week after operation was 50% higher than the pre-operative level in the laser group and 17% higher in the steel scalpel group. Two weeks post-operatively the respective differences were 38% in the laser group and 20% in the steel scalpel group. The mean DTPA disappearance rate was 34% lower 1 week after operation in the laser group and 23% lower in the steel scalpel group when compared with the preoperative state. Two weeks post-operatively the respective changes were 48 and 25%. These data indicate that there is no significant difference in renal function when the Nd: YAG combination laser technique is used in partial nephrectomy as compared with the steel scapel.

Detection of soft-tissue and skeletal infections with ultra low-field (0.02 T) MR imaging

To evaluate the use of ultra low-field (0.02 T) magnetic resonance (MR) imaging in the diagnosis of musculoskeletal infection, MR examinations with T2 weighted sequences were performed in 61 patients thought to be suffering from one of four major diagnostic categories: Soft-tissue abscesses (n = 22), osteomyelitis (n = 21), septic arthritis (n = 9) and spondylitis (n = 9). Infection was confirmed for 37 of these 61 patients. The verified abscesses, arthritis, spondylitis and acute osteomyelitis could be detected by 0.02 T MR. The sensitivity was poor in cases of chronic osteomyelitis. There was one false positive finding in a patient with a possible soft tissue infection. The 0.02 T MR examination failed four times. Two patients were too heavy and another 2 patients had magnetic material in or near the scanning field. Compared with computed tomography and isotope scanning, 0.02 T MR proved a little more informative, but without any statistical significance.

99mTc-DTPA and 99mTc-DMSA renal gamma imaging in the surveillance of patients with conduit urinary diversion

We studied renal anatomy and function using 99mTc-2-3 dimercaptosuccinic acid (DMSA) and 99mTc-diethylenetriaminepentaacetic acid (DTPA) in 27 patients with conduit urinary diversion. In this condition, free ureteral reflux is often associated with bacteriuria, and these factors are thought to precipitate progressive renal deterioration. Gamma-camera images provided valuable information concerning the structure of the renal parenchyma, the function of individual kidneys and possible ureteral obstruction, thus helping us to decide whether or not to instigate further treatment. The information gained using renal gamma imaging with 99mTc-DTPA and 99mTc-DMSA was complementary and partly overlapping. We preferred the use of 99mTc-DTPA because of its ability to visualise the ureters and the region of ureteroconduit anastomosis. Using diuretic medication, we were able to differentiate true ureteral obstruction from atony in 9 patients using 99mTc-DTPA.

The value of urethrocystography in the investigation of patients with spinal cord injury

In a review of 127 urethrocystograms carried out on 92 males with spinal cord injury the following conclusions were drawn. (1) In the presence of vesico-ureteric reflux or urethral reflux into the male adnexa, bladder outlet obstruction should be suspected. (2) Lesions of the anterior urethra develop easily as the result of indwelling catheterisation in patients lacking sensation. A retrograde urethrogram is necessary to demonstrate these lesions. (3) Severe trabeculation of the bladder wall can be a sign of high-pressure outlet obstruction. (4) Dilatation of the bladder neck in patients with detrusor sphincter dyssynergia may lead to total urinary incontinence after sphincterotomy. (5) Urethrocystography is not a valid investigation to detect bladder stones.

Upper urinary tract changes in patients with spinal cord injury

Two hundred and six intravenous urograms on 119 patients with spinal cord injury were reviewed and the findings correlated with the clinical data. Fifty (42%) of 119 patients had pathological changes in their upper urinary tracts. The most common feature was impaired renal emptying. Patients with normal and pathological upper tracts had similar findings according to the number of positive urine cultures during the first post-injury year, but in the follow-up those with pathological urograms showed bacteriuria significantly more often. Febrile urinary tract infections at least once a year were encountered in the follow-up of 40% of the patients with pathological urograms, as compared with 8% with normal urograms. All patients with severe renal changes had impaired emptying from the kidneys. This supports the view that the basic patho-physiological mechanism leading to upper tract deterioration in patients with spinal cord injury is a functional or mechanical obstruction of the lower urinary tract. This should be treated actively before irreversible renal changes develop.

Late haemodynamic response to metrizamide and ioxaglate in canine renal angiography. Preliminary report

The renal blood flow as examined in six dogs for 2 h after contrast agent injection into the renal artery using the dye dilution method. After injection of an ionic contrast agent (iodamide) there was an initial vasodilatation and later constriction, but the blood flow was back to normal after 10-15 min. Ioxaglate caused a similar initial response, but after a relatively large dose the blood flow remained below normal for 2 h. Metrizamide caused an immediate reduction in the blood flow, which remained constantly reduced for 2 h. A total cessation of the renal blood flow was seen in two cases.

Krypton-81m in the physiologic assessment of coronary arterial stenosis in man

Fifteen patients with frequent anginal chest pain underwent diagnostic cardiac catheterization. After coronary arteriography a specially designed cardiac catheter was seated in the aortic root, permitting the continuous infusion of krypton-81m into the right and left aortic sinuses. A gamma camera, areas of interest and a visual display unit were used to record images and the regional myocardial equilibrium of activity before, during and after a standarized atrial pacing test. The unique physical properties of krypton-81m allowed the continuous imaging and recording of moment to moment changes in regional myocardial perfusion. This investigation revealed that when the coronary arteriogram was normal or revealed lumonal stenosis of less than 50 percent, regional myocardial perfusion was uniform at rest and during stress. Two patients with a previous history of myocardial infarction had defects of regional perfusion at rest and during stress. Krypton scintigraphy demonstrated reversible regional defects in myocardial perfusion during stress in seven patients with greater than 70 percent stenosis of one or more coronary arteries. Alterations in regional myocardial perfusion occurred within 30 seconds of the start of atrial pacing in all the patients and preceded the onset of electrocardiographic signs of ischemia or chest pain.