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Christodoulopoulos N, Mastronikolis N, Tsiambas E, Jelastopulu E, Spyropoulou D, Lygeros S, Danielides G, Mastronikolis S, A Papadas T. Impact of different therapeutic regimens on survival of patients with nasopharyngeal carcinoma. J BUON 2019; 24:2418-2422. [PMID: 31983114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Nasopharyngeal carcinoma (NPC) demonstrates specific histo-genetic features that affect its biological behaviour. Our aim was to investigate the correlation between different therapeutic approaches and survival of patients with NPC in southwestern Greece based on specific clinicopathological features. METHODS Seventy-two NPC patients (n=72) were treated between 1990 and 2014 at the University Hospital of Patras. Patient demographics, tumor histology, use of tobacco and alcohol, exposure to mutagenic agents, chosen treatment and survival were recorded. All patients were treated with radiotherapy (RT), chemotherapy, surgery or their combinations. RESULTS In the patients who used immobilization mask during RT, the 5-year survival rate and overall survival was higher than the rest of patients (57% and 6 years vs. 13.6% and 3.36 years, p=0.0001, respectively)*. RT with mask combined with chemotherapy increased survival rates compared to RT without chemotherapy conventional regimen (p=0.0001). Additionally, patients who received chemotherapy demonstrated a 5-year survival of 51.6% compared to those without chemotherapy (11% p=0.0014). (*The 5-year survival rate group of patients refers to the percentage of people who will be alive 5 years after diagnosis. It does not include those who die from other diseases. Sometimes, this includes all people with a specific cancer type. Researchers call this an overall rate. In contrast, overall survival provides information for the length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the overall survival is one way to see how well a new treatment works.) Conclusions: In the majority of examined NPC cases treated with the use of immobilization RT mask along with chemotherapy, a significantly better prognosis compared to conventional RT-chemotherapy treatment was observed. Thus, chemotherapy offers an advantage to patient survival as an adjuvant treatment regimen in conjunction with RT.
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Affiliation(s)
- Nikolaos Christodoulopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Patras Medical School, Patras, Greece
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Gletsou E, Papadas TA, Baliou E, Tsiambas E, Ragos V, Armata IE, Metaxas GE, Fotiades PP. HPV infection in oropharyngeal squamous cell carcinomas: correlation with tumor size. J BUON 2018; 23:433-438. [PMID: 29745089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is implicated in carcinogenesis of a variety of epithelia, including oropharyngeal and laryngeal. High risk (HR) HPV persistent infection in head and neck squamous cell carcinomas (HNSCC) is a significant event, but its influence regarding the prognosis and survival in these patients remains under consideration. Our aim was to analyze a series of oropharyngeal (OP) SCCs at the HPV DNA level, correlating them to the survival status of the corresponding patients. METHODS Using HPV DNA polymerase chain reaction (PCR) microarray technology, 28 formalin-fixed, paraffinembedded primary OPSCCs were cored and analyzed. RESULTS Positive DNA amplicons for HPV infection were detected in 3 SCC cases (sub types: HPV 31/35/70). Interestingly, HPV persistent infection was associated with larger tumors (p=0.029) which also affected survival status (p=0.007) in the corresponding patients. Overall survival was also significantly dependent on the stage of the malignancies (p=0.022). Furthermore, tumor size was significantly and negatively correlated with age (p=0.015), meaning that younger patients will probably develop larger tumors. CONCLUSIONS HPV-depended OPSCCs - although not so common as the laryngeal ones, but still not so rare in the rural population in Greece - are characterized by a combination of specific features. Our results showed that survival was adversely effected by the stage of the disease and tumor size and indirectly by the presence of HPV - especially in young adults - while the combined surgery/radiotherapy/ chemotherapy therapy seems to prolong survival. Additionally, HPV co-existence seems to be associated with larger tumors and poor survival.
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Mastronikolis NS, Tsiambas E, Papadas TA, Karameris A, Ragos V, Peschos D, Mastronikolis SN, Papadas AT, Liatsos C, Armata IE, Fotiades PP. Deregulation of PTEN Expression in Laryngeal Squamous Cell Carcinoma Based on Tissue Microarray Digital Analysis. Anticancer Res 2017; 37:5521-5524. [PMID: 28982865 DOI: 10.21873/anticanres.11983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Phosphatase and tensin homolog (PTEN) (gene locus: 10q23.3) -a tumor suppressor gene- is deleted, mutated or epigenetically hyper-methylated in a variety of malignancies. PTEN acts as a negative regulator in PI3K/AKT/mTOR signaling transduction pathway. Our aim was to investigate PTEN protein expression patterns in laryngeal squamous cell carcinomas (LSCC). MATERIALS AND METHODS Using tissue microarray technology, fifty (n=50) primary LSCCs were cored and re-embedded into one recipient block. Immunohistochemistry and digital image analysis were implemented for evaluating protein expression levels. RESULTS Abnormal protein expression (low to negative staining intensity values) was observed in 28/50 (56%) tissue cores. Overall PTEN expression was associated with the anatomical region of the malignancies (p=0.039), whereas a borderline correlation with the differentiation grade was also assessed (p=0.05). CONCLUSION Aberrant expression of PTEN tumor-suppressor gene in LSCCs seems to affect their biological behavior. Well-differentiated tumors express moderate to high protein levels, an evidence of normal gene function, whereas loss of its expression correlates with a progressive tumor dedifferentiation. Additionally, loss of its expression is detected more frequently in specific anatomical regions of the larynx (glottis, predominantly, and partially supraglottis).
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Affiliation(s)
| | - Evangelos Tsiambas
- Department of Immunohistochemistry & Molecular Biology, 401 GAH, Athens, Greece
| | | | | | - Vasileios Ragos
- Department of Maxillofacial, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios Peschos
- Department of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Athanasios T Papadas
- Department of Hematology and Oncology, University of Wisconsin-Madison School of Medicine, Madison, WI, U.S.A
| | | | - Ilianna E Armata
- Medical School, St. George's, University of London medical programme, University of Nicosia, Nicosia, Cyprus
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Papadas TA, Tsiambas E, Mastronikolis NS, Karameris A, Mastronikolis SN, Papadas AT, Fotiades PP, Ragos V. Topoisomerase I deregulation in laryngeal squamous cell carcinomas based on tissue microarray analysis. J BUON 2017; 22:771-776. [PMID: 28730788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Topoisomerases (types: I/IIa-b/IIIa-b) represent a super-family of nucleic enzymes involved in the DNA replication, transcription, recombination, and also chromosome topological formation. Topoisomerase's I (Topo I- gene location: 20q12) aberrant expression is a frequent genetic event in a variety of solid malignancies. Topo I inhibition promotes cell death due to DNA damage and for this reason it is a target for specific targeted chemotherapy (camptothecin, topotecan, irinotecan). Our aim was to investigate the role of abnormal Topo I protein expression in laryngeal squamous cell carcinomas (LSCC) in which there are very limited data regarding the influence of the marker. METHODS Using tissue microarray (TMA) technology, 50 formalin-fixed, paraffin-embedded primary laryngeal SCCs were cored and re-pembedded into one recipient block. Immunohistochemistry was performed using anti- Topo I antibody. Digital image analysis was also implemented for evaluating objectively the protein expression levels on the corresponding stained nuclei. RESULTS Topo I protein overexpression (moderate to high staining intensity values) was observed in 32/50 (64%) tissue cores, whereas low expression rates were detected in 18/50 (36%) cases. Topo I overall expression was strongly associated with the differentiation grade of the examined tumors (p=0.021). No other statistical correlations were identified. CONCLUSIONS Topo I overexpression is observed in a significant subset of LSCCs affecting the level of differentiation in them. Additional molecular studies focused on the mechanism of Topo I gene/protein deregulation (i.e. amplification, abnormal epigenetic promoter methylation, mRNA aberrant expression) are necessary discriminating the eligible patients for applying specific chemotherapeutic strategies based on anti-Topo I agents.
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Affiliation(s)
- Theodoros A Papadas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Patras; Patras, Greece
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Mastronikolis NS, Tsiambas E, Papadas TA, Fotiades PP, Papadas AT, Mastronikolis SN, Kastanioudakis I, Ragos V. mTOR deregulation in oral cavity squamous cell carcinoma. J BUON 2017; 22:610-613. [PMID: 28730764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Signal transduction pathways consist of a variety of inter- and intra-cellular molecules. They act as supporting mechanisms for cell survival and homeostasis. Among them, the phosphatidylinositol 3-kinase (PI3K)/tumor suppressor phosphatase and tensin homologue deleted on chromosome ten (PTEN)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway plays a crucial role in regulating normal cell growth based on growth factor receptors (GFRs) interaction, including epidermal GFR (type II-HER2) and insulin GFR (IGF). mTOR protein acts as a serine-threonine kinase that belongs to the PI3K-related kinase family. It mediates protein and lipid synthesis, mitochondrial metabolism, biogenesis, proliferation and also negatively regulates autophagy. Two distinct multiprotein complexes have been mainly identified and cloned: mTOR complex 1 (mTORC1) and mTOR complex 2 (mTORC2). mTOR is deregulated predominantly due to mutations, deletions, loss of heterozygosity (LOH) or abnormal phosphorylation of the upstream molecules inside the current pathway. Pure mTOR mutations are very rare. Development of specific inhibitors at the basis of targeted therapeutic strategies such as rapamycin (rapalogs) is an evolution in handling patients with mTOR abnormal overactivity. In the current special article we explored the role of the gene deregulation leading to abnormal protein expression in oral cavity squamous cell carcinoma (SCC).
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Affiliation(s)
- Nicholas S Mastronikolis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Patras, Patras, Greece
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Mastronikolis NS, Spiliopoulou SP, Zolota V, Papadas TA. Horner's Syndrome Incidental to Medullary Thyroid Carcinoma Excision: Case Report and Brief Literature Review. Case Rep Otolaryngol 2016; 2016:7348175. [PMID: 27200201 PMCID: PMC4856912 DOI: 10.1155/2016/7348175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/10/2016] [Indexed: 11/25/2022] Open
Abstract
Horner's syndrome is characterized by a combination of ipsilateral miosis, blepharoptosis, enophthalmos, facial anhidrosis, and iris heterochromia in existence of congenital lesions. The syndrome results from a disruption of the ipsilateral sympathetic innervation of the eye and ocular adnexa at different levels. Though rare, thyroid and neck surgery could be considered as possible causes of this clinical entity. We present a case of Horner's syndrome in a patient after total thyroidectomy and neck dissection for medullary thyroid cancer with neck nodal disease and attempt a brief review of the relevant literature.
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Affiliation(s)
- Nicholas S. Mastronikolis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
| | - Sofia P. Spiliopoulou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
| | - Vassiliki Zolota
- Department of Pathology, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
| | - Theodoros A. Papadas
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Patras Medical School, 26504 Rio, Patras, Greece
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Panogeorgou T, Tserbini E, Filou S, Vynios DH, Naxakis SS, Papadas TA, Goumas PD, Mastronikolis NS. Hyaluronan synthases and hyaluronidases in nasal polyps. Eur Arch Otorhinolaryngol 2015; 273:1801-8. [PMID: 26661071 DOI: 10.1007/s00405-015-3848-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/28/2015] [Indexed: 11/25/2022]
Abstract
Nasal polyps (NPs) are benign lesions of nasal and paranasal sinuses mucosa affecting 1-4 % of all adults. Nasal polyposis affects the quality of patient's life as it causes nasal obstruction, postnasal drainage, purulent nasal discharge, hyposmia or anosmia, chronic sinusitis, facial pain and snoring. Without treatment, the disease can alter the craniofacial skeleton in cases of extended growth of polyps. The development of NPs is caused by the hyperplasia of nasal or paranasal sinuses mucosa, and edema of extracellular matrix. This is usually the result of high concentration of high molecular mass hyaluronan (HA) which is either overproduced or accumulated from blood supply. The size of HA presents high diversity and, especially in pathologic conditions, chains of low molecular mass can be observed. In NPs, chains of about 200 kDa have been identified and considered to be responsible for the inflammation. The purpose of the present study was the investigation, in NPs and normal nasal mucosa (NM), of the expression of the wild-type and alternatively spliced forms of hyaluronidases, their immunolocalization, and the expression of HA synthases to examine the isoform(s) responsible for the increased amounts of HA in NPs. Hyaluronidases' presence was examined on mRNA (RT-PCR analysis) and protein (immunohistochemistry) levels. Hyaluronan synthases' presence was examined on mRNA levels. Hyaluronidases were localized in the cytoplasm of epithelial and inflammatory cells, as well as in the matrix. On mRNA level, it was found that hyal-1-wt was decreased in NPs compared to NM and hyal-1-v3, -v4 and -v5 were substantially increased. Moreover, HAS2 and HAS3 were the only hyaluronan synthases detected, the expression of which was almost similar in NPs and NM. Overall, the results of the present study support that hyaluronidases are the main enzymes responsible for the decreased size of hyaluronan observed in NPs; thus they behave as inflammatory agents. Therefore, they could be a potential target for the design of a more advanced treatment for nasal polyposis.
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Affiliation(s)
- T Panogeorgou
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Patras, University of Patras Medical School, 26500, Patras, Greece.
| | - E Tserbini
- Biochemistry, Biochemical Analysis and Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, 26500, Patras, Greece
| | - S Filou
- Biochemistry, Biochemical Analysis and Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, 26500, Patras, Greece
| | - D H Vynios
- Biochemistry, Biochemical Analysis and Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, 26500, Patras, Greece
| | - S S Naxakis
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Patras, University of Patras Medical School, 26500, Patras, Greece
| | - T A Papadas
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Patras, University of Patras Medical School, 26500, Patras, Greece
| | - P D Goumas
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Patras, University of Patras Medical School, 26500, Patras, Greece
| | - N S Mastronikolis
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Patras, University of Patras Medical School, 26500, Patras, Greece
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Dimaka K, Mallis A, Naxakis SS, Marangos M, Papadas TA, Stathas T, Mastronikolis NS. Chronic rhinocerebral mucormycosis: a rare case report and review of the literature. Mycoses 2014; 57:699-702. [PMID: 25039925 DOI: 10.1111/myc.12219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/07/2014] [Accepted: 06/12/2014] [Indexed: 12/17/2022]
Abstract
Rhinocerebral mucormycosis is an invasive infection caused by filamentous fungi of the Mucoraceae family. The rhinocerebral form of the disease represents the most common form and has two distinct clinical entities. The common presentation consists of a rapidly progressive infection with high mortality rate, while the other presentation is that of a chronic infection with lower mortality. In the present paper we report a rare case of chronic rhinocerebral mucormycosis. An 85-year-old male with a 6-month history of purulent and odorous nasal discharge, and sporadic episodes of epistaxis and anosmia, presented to the outpatient department of our clinic. Initial cultures were positive only for Pseudomonas aeruginosa. The patient was unresponsive to ciprofloxacin treatment, developing necrotic areas of the nasal septum suspicious for rhinocerebral mucormycosis. Admission to the ENT clinic followed, with histopathologic evaluation of the vomer bone confirming the diagnosis. The patient was treated with amphotericin B and was discharged 3 weeks later on oral posaconazole therapy. Chronic rhinocerebral mucormycosis may present with atypical symptoms or coinfection with another agent. A high degree of clinical suspicion is required for correct diagnosis and prompt initiation of appropriate treatment.
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Tsiambas E, Rallis E, Papadas TA, Salemis N, Christodoulou I, Metaxas GE, Athanasiou AE, Karameris A. Amelanotic melanoma: a case with chr 9 monosomy. J BUON 2014; 19:582-583. [PMID: 24965431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Evangelos Tsiambas
- Dept of Immunohistochemistry and Mocelular Biology, 401 General Army Hospital, Athens, Greece
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Stathas T, Mallis A, Mastronikolis NS, Naxakis SS, Dimaka K, Panogeorgou T, Stavrou S, Margaritis V, Kourousis C, Papadas TA. Pharyngocutaneous fistula complicating laryngectomy: can metronidazole help? ORL J Otorhinolaryngol Relat Spec 2011; 73:291-4. [PMID: 21952008 DOI: 10.1159/000330275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 06/22/2011] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the use of metronidazole as a prophylactic agent against pharyngocutaneous fistula (PCF) formation. PATIENTS AND METHODS Seventy patients who underwent total laryngectomy between 2000 and 2008 in our department were divided into two groups. The first group (M+ group) was placed on a 10-day metronidazole regimen (2 days prior to surgery and 7 days following). The second group (M- group) received only regular preoperative chemoprophylaxis. RESULTS In total, 17 (24.3%) incidents of PCF were reported, 3 of which were in the M+ group, with the remainder in the M- group. A statistically significant reduction in the PCF rate was noted in favor of metronidazole in the overall population (p = 0.005), as well as in the patient group that had received radiotherapy prior to surgery (p = 0.03). CONCLUSION Metronidazole administered for a total of 10 days pre- and postoperatively seems to lower the incidence rate of PCF formation.
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Mallis A, Goumas PD, Mastronikolis NS, Panogeorgou T, Stathas T, Prodromaki K, Papadas TA. Factors influencing quality of life after total laryngectomy: a study of 92 patients. Eur Rev Med Pharmacol Sci 2011; 15:937-942. [PMID: 21845804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Total laryngectomy is a radical surgery for advanced laryngeal cancer. In the present study we evaluate the influencing factors for long term quality of life of 92 laryngectomees. PATIENTS AND METHODS 92 patients who underwent laryngectomy for laryngeal cancer in the University Hospital of Patras, Greece were evaluated using a modified version of the EORTC-QOL-C30 questionnaire. The patients were distributed into 6 groups based on time elapsed between surgical treatment and completion of the questionnaire, ranging from 2 years for group 1 to 9-10 years for group 6. RESULTS The mean value of psychological status (p=0.01), smelling disorders (p=0.032), mood change (p=0.003) were statistically significant in regard to the patient's overall view of their life postsurgically. Coexisting illness (defined as diabetes, hypertension or prostate disease which required medication on daily basis or hospitalization more than two times a year) was also significantly affecting (p=0.021) the patient's oral communication skills. CONCLUSION Quality of life is affected by functional disabilities and the psychological state of the patients. No statistically significant improvement over time was noted in our series.
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Affiliation(s)
- A Mallis
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine University Hospital of Patras, Patras, Greece
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Mallis A, Teymoortash A, Mastronikolis NS, Werner JA, Papadas TA. MMP-2 expression in 102 patients with glottic laryngeal cancer. Eur Arch Otorhinolaryngol 2011; 269:639-42. [PMID: 21667117 DOI: 10.1007/s00405-011-1625-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
Abstract
In order to evaluate the potential of matrix metalloproteinase 2 (MMP-2) as a prognostic factor for glottic laryngeal cancer. One hundred and two surgical specimens from patients with glottic laryngeal cancer who underwent laryngectomy for their disease in the University Hospital of Patras, Greece from 1998 to 2005 were reviewed retrospectively regarding MMP-2 expression via immunohistochemistry. Immunostaining was performed using a streptavidin-biotin peroxidase complex technique (LSAB). Results revealed that 54 of 102 patients (52.9%) had positive cytoplasmic staining for MMP-2. Kaplan-Meier analysis demonstrated statistically significant difference (p = 0.037) for the 5-year overall survival rate between the groups with positive and negative MMP-2 expression, and marginal statistical significance for the disease free survival rate (p = 0.048). The capsule rupture of metastatic lymph nodes and MMP-2 expression in primary tumor site also seems to be related (p = 0.047). Statistical significance could not be established between MMP-2 expression and the clinicopathological features of the disease (T stage, N stage, clinical stage, differentiation). In conclusion, MMP-2 expression was related with worse overall and disease-free survival and could be considered as a potential marker of poor prognosis.
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Affiliation(s)
- Antony Mallis
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Patras, 26500, Rion Patras, Greece.
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Mallis A, Mastronikolis NS, Koumoundourou D, Stathas T, Papadas TA. Sinonasal sarcoidosis. A case report. Eur Rev Med Pharmacol Sci 2010; 14:1097-1099. [PMID: 21375142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Sarcoidosis is a granulomatous disease of unknown etiology, which in the majority of cases affects the lower respiratory tract. Although neck mass, parotid swelling and facial nerve palsy are considered the primary complaints in cases of head and neck sarcoidosis, sinonasal localization of the disease is also uncommonly reported. CASE A 46 year old woman presented in our clinic with complaints of nasal congestion over a six month period. The patient reported increasing symptom severity in the last month with occasional purulent discharge. No other symptoms were reported. The patient's medical record was significant only for sarcoidosis localized to the lower respiratory tract. On anterior rhinoscopy, the nasal mucosa presented marked hypertrophy, purplish discoloration and granulomatous appearance of the inferior turbinates on the left side. The diagnosis of sinonasal sarcoidosis was made based on histopathologic examination of biopsy specimens. CONCLUSION Sinonasal sarcoidosis presents a challenging issue for the clinicial as its mimicking features may be misleading and delay diagnosis. In the present paper we present a case of sinonasal sarcoidosis presenting as chronic rhinosinusitis.
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Affiliation(s)
- A Mallis
- ENT Department, University Hospital of Patras, Greece.
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Mallis A, Jelastopulu E, Mastronikolis NS, Naxakis SS, Kourousis C, Papadas TA. Laryngeal cancer and passive smoking: the neglected factor? Eur Arch Otorhinolaryngol 2010; 268:727-31. [PMID: 20963601 DOI: 10.1007/s00405-010-1403-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
Abstract
In the present paper we investigate the relationship of environmental tobacco smoke (ETS) exposure to laryngeal cancer. 209 patients who were diagnosed with laryngeal cancer from 2000 to 2009 at the University Hospital of Patras, Western Greece, were reviewed with regard to patient age, disease stage at presentation, tumor differentiation, tobacco product use, alcohol consumption, occupation, and ETS exposure in the working environment. Pearson Chi-square method was used to determine the effect of ETS exposure on cancer stage, TNM classification and tumor differentiation in the dichotomized population (exposed vs. not exposed) and in groups of low, medium and high ETS exposure. ETS exposure in the working environment was found to significantly affect overall disease stage and T stage (p < 0.01) both in the dichotomic analysis and the group analysis. Minor significance was also noted for N stage (p = 0.047) in the exposure group analysis. Our data suggest that occupational ETS exposure presents a contributing risk factor for laryngeal cancer that requires further research to determine its significance.
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Affiliation(s)
- Antonios Mallis
- ENT Department, University Hospital of Patras, Patras, Greece.
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Papadas TA, Alexopoulos EC, Mallis A, Jelastopulu E, Mastronikolis NS, Goumas P. Survival after laryngectomy: a review of 133 patients with laryngeal carcinoma. Eur Arch Otorhinolaryngol 2009; 267:1095-101. [PMID: 19921233 DOI: 10.1007/s00405-009-1156-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 11/05/2009] [Indexed: 01/09/2023]
Abstract
Survival trends in survival for laryngeal cancer in Europe are varied. Five-year survival varied around 60-64% but numbers below 50% have been commonly reported. The aim of this study was to assess the factors influencing survival in patients with laryngeal cancer in our region. A total of 128 male and 5 female patients with larynx cancer (91 glottic and 42 supraglottic) were treated at Patras University Hospital between March 1992 and August 2004. Except 3, all were smokers and 56 (41%) heavy alcohol users. Postsurgical staging showed that most had been classified at stages III (38%) and IV (49%). By histology, 31 tumors were classified as poorly differentiated, 78 as moderately differentiated and 23 as well differentiated. All patients underwent laryngectomy with extension of the procedure where appropriate. Also, a total of 45 patients received adjuvant therapy (either chemotherapy or radiotherapy). Farmers, construction workers, professional drivers and mechanics and coffee shop and bar employees account for more than 70% of patients. Results showed that 64 (48.1%) patients died during the follow-up, 58 (43.6%) of them died from cause related to their disease. With a median follow-up of 25 months, the 5-year disease-free survival (DFS) was 53% and the 5-year overall survival (OS) was 45%. Significant prognostic factors for OS included patient age, advanced staging, heavy alcohol use and poor tumor differentiation while for DFS affected mainly by poor tumor differentiation. We conclude that the disease stage at presentation, tumor grade and alcohol consumption prove to be important predictors for the OS as well as the DFS in our series.
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Mastronikolis NS, Papadas TA, Marangos M, Karkoulias KP, Tsamandas AC, Goumas PD. Tuberculosis of the parotid gland. Tuberk Toraks 2009; 57:84-88. [PMID: 19533444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Tuberculosis (Tbc) presented as an isolated parotid mass is rare. Preoperative diagnosis is difficult and the symptomatology is nonspecific. In the majority of the cases an initial diagnosis of a parotid tumor, often a pleomorphic adenoma, is made. We present a 35-year old woman with a six months duration right parotid lump. The mass was firm and nontender without ipsilateral cervical lymphadenopathy, suggesting a parotid neoplasm. The computerized tomography scan showed an intraparotideal tumor resembling a pleomorphic adenoma and thus the patient underwent to a superficial parotidectomy. Fine needle aspiration biopsy was performed but it was not diagnostic. Histological examination revealed an intraparotideal lymph node with changes of granulomatous lymphadenopathy type, like those demonstrated in the tuberculosis and sarcoidosis. Ziehl-Nielsen staining was negative, while the tuberculin skin test (PPD, 5 IU) was positive. The patient's treatment regimen consisted of a 2-month initial phase of isoniazid, rifampin, pyrazinamide and ethambutol followed by a 7 month continuation phase of isoniazid and rifampin. Postoperatively, there was only a mild paresis of the facial nerve resolved a week after. Parotid Tbc is very rare but should be considered as a differential diagnosis of parotid lumps. Fine needle aspiration biopsy (FNAB) is of outmost importance for diagnosis, since the treatment of this entity is primarily conservative. However, surgery could be both therapeutic and diagnostic, especially when other diagnostic examinations fail.
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Mastronikolis NS, Stathas T, Papadas TA, Spyropoulos K, Naxakis S, Goumas PD. Voice restoration after total laryngectomy using provox 2 (generation II) prosthesis. Eur Rev Med Pharmacol Sci 2008; 12:327-330. [PMID: 19024218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Voice restoration after total laryngectomy is of outmost importance for patient and a therapeutic challenge for the surgeon and speech pathologist. Among various rehabilitation methods prosthetic voice yields nowadays the best results. PATIENTS AND METHODS A total of 12 patients underwent laryngectomy at the Department of Otorhinolaryngology, University Hospital, Patras, Greece, between February 2006 and May 2007. All patients had advanced laryngeal squamous cell carcinoma. Eight patients had primary voice prosthesis inserted and four patients had a tracheo-esophageal puncture (TEP) carried out as a secondary procedure. RESULTS The majority of the patients (80%) from both the primary insertion or the secondary insertion group, developed good and understood speech using the prosthesis. No significant difference in quality of speech was found between the two subgroups. Four patients required replacement of the prosthesis at intervals of 8 and 10 months after insertion, because of salivary leakage and granulation formation around the fistula, while 3 patients developed a mild mucositis and tracheitis due to postoperative radiotherapy. DISCUSSION TEP puncture and prosthesis insertion is a relatively simple, safe and effective surgical procedure for voice restoration after laryngectomy. Provox 2 (generation II) voice prosthesis is a new and useful modified device that has overcome the previous prosthesis drawbacks, is well tolerated by the patients and can be easily changed via the front-loading technique.
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Affiliation(s)
- N S Mastronikolis
- Department of Otorhinolaryngology, University Hospital of Patras, School of Medicine, Patras, Greece.
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Stylianou M, Skandalis SS, Papadas TA, Mastronikolis NS, Theocharis DA, Papageorgakopoulou N, Vynios DH. Stage-related decorin and versican expression in human laryngeal cancer. Anticancer Res 2008; 28:245-251. [PMID: 18383852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The major proteoglycan of normal human larynx is aggrecan. In laryngeal carcinoma, aggrecan is depleted, with versican and decorin appearing in higher amounts. MATERIALS AND METHODS Proteoglycans in laryngeal carcinoma samples were characterized immunohistochemically and using Western blotting; their expression was examined by RT-PCR. RESULTS Aggrecan was totally removed in advanced cancer and its RT-PCR product was not identified. Both versican and decorin were overexpressed in cancer, versican much more than decorin. Decorin expression was higher than that of versican in the normal larynx; therefore, their disproportionate overexpression during cancer resulted in about equimolar expression. Both proteoglycans' expression correlated with their stage-related accumulation within the tissue. CONCLUSION These data add to our previous findings and support the view that the levels of expression and the extent of accumulation and localization in the tumor stroma of structurally modified versican and decorin could be associated with the degree of aggressiveness of laryngeal carcinoma.
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Affiliation(s)
- M Stylianou
- Laboratory of Biochemistry, Department of Chemistry, University of Patras, 26500 Patras, Greece
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Papadas TA, Karkoulias KP, Mastronikolis NS, Sampsonas FL, Spiropoulos KB. Concurrent tonsillitis and pneumonia due to S. pyogenes. Clin Ter 2008; 159:33-34. [PMID: 18399260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Tonsillitis is a common disease especially of children and young adults. The diagnosis of tonsillitis generally requires the consideration of Group A beta-hemolytic streptococci infection. Pneumonia is an inflammation of the alveoli and terminal airspaces in response to invasion by an infectious agent that is introduced into the lungs through hematogenous spread or inhalation. We present a case of a concurrent acute tonsillitis and pneumonia due to S. pyogenes. To our knowledge, a similar case has not been previously described in the literature.
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Affiliation(s)
- T A Papadas
- Department of Otorhinolaryngology, Division of Pneumology, University Hospital of Patras, Greece
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Christopoulos TA, Papageorgakopoulou N, Ravazoula P, Mastronikolis NS, Papadas TA, Theocharis DA, Vynios DH. Expression of metalloproteinases and their tissue inhibitors in squamous cell laryngeal carcinoma. Oncol Rep 2007; 18:855-60. [PMID: 17786346 DOI: 10.3892/or.18.4.855] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The hallmark of cancer invasion is the degradation of extracellular matrix components. Matrix metalloproteinases are the major enzymes participating in this event and their activity is regulated extracellularly by their presence as proenzymes and the concomitant presence of the specific tissue inhibitors. The present study describes the immunohistochemical localization of gelatinases, matrix metalloproteinase (MMP)-2 and -9 and tissue inhibitor of metalloproteinase (TIMP)-1 and -2 in human laryngeal carcinoma and their expression with respect to tumor classification and compared with the respective healthy subjects. MMP-2 was immunolocalized in the cytoplasm of the epithelial cells and in the loose connective tissue, whereas MMP-9 was also observed in basement membrane and chondrocytes. Both were also found in tumor cells, but staining was decreased with increasing stage of cancer. TIMP-1 was present exclusively in stroma and totally absent from tumor cells and it was overexpressed in normal cells surrounding the tumor. TIMP-2 was identified in the cytoplasm of epithelial cells, in stroma and sometimes in chondrocytes. In addition, it was present in tumor cells of only stage IV samples. The expression level of both gelatinases and TIMPs increased as the stage of cancer increased, suggesting the possible post-transcriptional removal of their mRNA. These observations, performed in a given head and neck site, suggest that the behavior of head and neck tumors seems to depend on the site and additional studies should be performed to obtain a general understanding of the disease and ascertain the role of the constituents examined.
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Affiliation(s)
- T A Christopoulos
- Laboratory of Biochemistry, Department of Chemistry, University of Patras, 26500 Patras, Greece
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Mastronikolis NS, Tsiropoulos GE, Chorianopoulos D, Liava ACH, Stathas T, Papadas TA. Palatine tonsillar metastasis from lung adenocarcinoma. Eur Rev Med Pharmacol Sci 2007; 11:279-282. [PMID: 18074935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Tonsillar metastasis from lung cancer is an extremely rare event and is usually related to metastatic spread of the neoplastic disease to other organs with poor prognosis. We present the unusual case of a 71-year-old man who developed a huge metastasis to the left palatine tonsil from a lung adenocarcinoma. The tumor was exophytic with necrotic and hemorrhagic areas, occupying a large portion of the oropharynx and producing airway obstruction, thus necessitating tracheostomy. Radiation therapy was delivered in an attempt to reduce the size of the tumor. Although a mild decrease of the tonsillar mass was noted, the designed therapy had to be discontinued because of a rapid deterioration of the patient's general condition. The patient finally died of disseminated disease. This case highlights the need for a thorough evaluation of a suspicious tonsillar enlargement, as this may be a sign of a primary malignancy elsewhere in the body.
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Affiliation(s)
- N S Mastronikolis
- Department of Otorhinolaryngology, University of Patras Medical School, Patras, Greece.
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Christopoulos TA, Papageorgakopoulou N, Theocharis DA, Aletras AJ, Tsiganos CP, Papadas TA, Mastronikolis NS, Goumas P, Vynios DH. Diagnostic and classification value of metalloproteinases in squamous human laryngeal carcinoma. Int J Oncol 2004; 25:481-5. [PMID: 15254747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Metalloproteinases (MMPs) are a class of enzymes largely involved in tumour progression and metastasis. At least twenty different enzymes are recognized that are also present under normal state of tissues. Their activity is regulated by their presence as proenzymes and by the concomitant presence of the respective tissue inhibitors (TIMPs). The present study describes the alterations of MMPs observed in human laryngeal carcinoma with respect to tumour classification and compares their activity in normal and cancerous tissues and biopsy specimens. Samples from five patients who underwent laryngectomy, from five biopsies and three from autopsies were used. The MMPs of normal and malignant human laryngeal cartilage and of biopsy specimens were identified immunochemically and by zymography using gelatin or casein as substrates. Healthy cartilage from autopsies was found to contain almost exclusively MMP-1, proMMP-2 and proMMP-9. Normal parts from laryngectomies contained, in addition, significant amounts of active MMP-2. The respective malignant parts contained both MMP-2 and -9 in increased amounts in their latent and active forms. Similar profile of MMPs was also identified in tissues surrounding affected cartilage. These alterations were found to be in good accordance with tumour stage and were also observed in biopsy samples. Thus, analysis of MMPs in biopsies can be used together with the clinicopathological parameters for the classification or early diagnosis of laryngeal tumours.
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Affiliation(s)
- T A Christopoulos
- Laboratory of Biochemistry, Department of Chemistry, University of Patras, 265 00 Patras, Greece
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Goumas PD, Naxakis SS, Rentzis GA, Tsiotos PD, Papadas TA. Lateral neck abscess caused by Streptococcus bovis in a patient with undiagnosed colon cancer. J Laryngol Otol 1997; 111:666-8. [PMID: 9282212 DOI: 10.1017/s0022215100138277] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Bacteraemia or endocarditis caused by Streptococcus bovis, a non-enterococcal group D streptococcus, is a very common finding in patients suffering from intestinal tumours or other colon diseases. A case of a patient with a laternal neck abscess caused by S. bovis is reported. During the treatment the patient was found to have colonic malignant lesions. The problems in the appropriate diagnosis and the possible correlation between these two clinical entities are presented and discussed.
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Affiliation(s)
- P D Goumas
- E.N.T. Department, University Hospital of Patras, Greece
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