Assessment of the presence of interleukin 17+ macrophages and Th17 cells in situ in lip and oral tongue cancer

Increasing clinical evidence indicates that Th17 cells may promote or inhibit tumor progression, however the exact role of these cells in Oral Squamous Cell Carcinoma (OSCCs) pathogenesis and progression remains unclear. Tumor associated macrophages are highly plastic phenotype cells which can differentiate as M1 or M2. The mechanism and cellular phenotype of IL-17 expressing macrophages are unknown. 40 cases of lip and 28 of tongue SCCs were submitted to immunohistochemical analysis, and histologically graded. In tongue cases TNM was analyzed. The number of IL-17⁺ T cells was higher in lip SCC (p = 0.028). IL-17⁺ macrophages was greater in tongue SCC (p = 0.014). There were more IL-17⁺ macrophages in the high-grade malignancy oral tongue SCCs (p = 0.016), yet there was no significant difference in the numbers of RORγt⁺ lymphocytes by histopathological or TNM analysis. This study provides evidence concerning IL-17's pleiotropic roles, being possibly dependent on its cellular sources in the tumor microenvironment.

High CD3+ lymphocytes, low CD66b+ neutrophils, and scarce tumor budding in the invasive front of lip squamous cell carcinomas

OBJECTIVE

This study aimed to evaluate tumor budding (TB) and quantify the neutrophilic and lymphocytic infiltration in the invasive front of lip squamous cell carcinomas. In addition, the associations between these features and the histopathological grading in the invasive front were analyzed.

DESIGN

A total of 43 lip squamous cell carcinoma surgical specimens were included and classified in accordance with a histological invasive front grading system. Immunohistochemistry was performed for CD66b and CD3 for the evaluation of neutrophils and T lymphocytes, respectively, in the invasive front of the tumors. Tumor budding was evidenced by AE1/AE3 staining.

RESULTS

Thirty-six (83.7%) of the tumors were well-differentiated tumors. Eleven (25.6%) of the cases exhibited high-intensity tumor budding. There were low neutrophil and high T lymphocyte infiltrations in the invasive front, leading to a low neutrophil/T lymphocyte ratio in the same region. Moreover, we found an association between tumor budding and the pattern of invasion, and between the CD3⁺ cell count and the inflammatory infiltrate (p < 0.05).

CONCLUSIONS

The low neutrophil and high T lymphocyte infiltration in the invasive front, and the few high-intensity tumor budding cases are in accordance with the histopathological features of well-differentiated lip tumors. If these characteristics remain in lip squamous cell carcinomas with more aggressive histopathological features, it deserves to be investigated.

Herpes Simplex Virus and Human Cancer. III. Search for Relationship of Herpes Simplex Antibodies and Cervical Dysplasia and Labial Neoplasia

We employed the enzyme-linked immunosorbent assay (ELISA), indirect hemagglutination (IHA), and complement fixation (CF) methods to measure antibody titer to herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in patients affected by labial tumors or cervical dysplasias. No relationship of antibody titer to HSV-1 and labial tumors was detected by any of the three methods. Association between antibody titer to HSV-2 and cervical dysplasias was revealed by IHA (p < 0.05) and ELISA (p < 0.001); CF tests were negative. Moreover, we assayed for HSV-specific antigens in cell cultures derived from labial tumors and cervical dysplasias. In cultures from labial tumors, it was not possible to detect HSV-specific antigens. Of the 25 cultures derived from cervical dysplasias, HSV antigens were found in only 3 cultures.

Characterization of a Herpes Simplex Virus Isolated from a Lip Tumor Developing after Recurrent Herpes

A spindle-cell carcinoma developed on the lower lip of 53-year-old patient who had suffered from recurrent local herpes. From a tumor biopsy a human herpesvirus 1 (Type 1 Herpes Simplex Virus) was isolated (strain n. 466). Infected cells contain eosinophilic intranuclear inclusions (fig. 3); the agent's cpe is abolished by anti-HSV antiserum and by chloroform; the agent produces typical plaques (fig. 4), grows at 38 °C, and its DNA has a density of approximately 1.726 g per cm3, equal to that of DNA of « F » prototype of human herpesvirus 1 (text-fig. 1). However, its immunological structure (text-fig. 2) and its protein electrophoretic pattern (fig. 5) slightly differentiate this virus from homotypic strains including some local isolates. At the time the virus was isolated from the tumor no HSV was recovered from the surrounding skin of the patient. After surgical removal of the tumor, the patient suffered no more of herpetic recurrences. As far as the significance of the isolation is concerned, UV-inactivated strains possess a transforming activity in vitro and human herpesvirus 2 is known to be associated to cervical carcinoma in some human populations, but no direct oncogenicity has been shown in HSV. In our case, HSV may have been implicated through the association of the irritant effect of repeated recurrences and a possible abortive type of infection with cigarette smoking.

Immunohistochemical expression of DNA methyltransferases 1, 3a, and 3b in actinic cheilitis and lip squamous cell carcinomas

BACKGROUND

Epigenetic modifications, including DNA methylation of tumor suppressor genes carried out by DNA methyltransferases (DNMTs), are important events in carcinogenesis. Although there are studies concerning to its expression in several cancer types, DNMTs expression pattern is not known in photoinduced lip carcinogenesis. The aim of this study was to investigate the immunoexpression of DNMTs 1, 3a, and 3b in lip precancerous lesion (actinic cheilitis) and cancer.

METHODS

Thirty cases of actinic cheilitis (AC), thirty cases of lip squamous cell carcinoma (LSCC), and twenty cases of non-neoplastic tissue (NNT) were selected for immunohistochemical investigation of DNMTs 1, 3a, and 3b.

RESULTS

Nuclear DNMT 1 immunoreactivity was significantly higher in the LSCC group (68.6%) compared with NNT (47%), and nuclear DNMT 3b was higher in LSCC (70.9%) than in NNT (37.9%) and in AC (44%). Only DNMT 3a showed both higher nuclear and cytoplasmic expression in AC (35.9% and 35.5%, respectively) than in NNT (4.4% and 16.1%, respectively) and LSCC (8.8% and 13.2%, respectively) (P < 0.05).

CONCLUSIONS

The results suggested that DNMT 3a could play a key role in the methylation process of initial steps of UV carcinogenesis present in AC while DNMT 3b could be responsible for de novo methylation in already established lip cancer.

CD1a+ and CD83+ Langerhans cells are reduced in lower lip squamous cell carcinoma

BACKGROUND

Actinic cheilitis (AC) is a potentially malignant lesion diagnosed in the lip of patients chronically exposed to the sun that may give rise to a fully invasive lower lip squamous cell carcinoma (LLSCC). It is known that ultraviolet radiation causes dendritic cells (DCs) depletion in the epidermis, but the role of this cellular population in lip cancer progression remains uncertain. Therefore, this study investigated the distribution of DCs in normal, dysplastic and neoplastic tissues of the lower lip.

METHODS

Thirteen cases of lower lip mucocele, 42 of ACs and 21 of LLSCC were retrieved and original diagnoses confirmed by two oral pathologists, who further classified ACs as low- and high-risk lesions. Immunoreactions against CD1a and CD83 identified immature and mature DCs, respectively.

RESULTS

Immature CD1a+ Langerhans cells (LCs) were significantly decreased in LLSCC when compared to morphologically normal (P < 0.009) and dysplastic epitheliums (P < 0.003), whereas mature CD83+ LCs were significantly decreased in LLSCC when compared to normal epithelium (P = 0.038). There was no significant difference between low- and high-risk ACs regarding CD1a+ and CD83+ LCs (P > 0.05), but ACs demonstrated a lower concentration of CD1a+ LCs than normal epithelium (P < 0.009). There was no significant difference in the distribution of CD1a+ and CD83+ interstitial dendritic cells (IDCs) in the connective tissue among the studied groups (P > 0.05).

CONCLUSION

These results suggest that depletion of epithelial LCs, but not IDCs in the connective tissue, would represent an important step for lip cancer development.

Keratoacanthoma in the inferior lip of an immunosuppressed patient. A case report

Keratoacanthoma is a lesion typical crater, symmetrical, rounded, rapid growth with high potential for self-involution. The lesions may be multiple, disseminated and associated with some syndromes. The etiology of keratoacanthoma is not known, but it is often observed in patients chronically exposed to sun. Histopathological features of keratoacanthoma may resemble those of a well differentiated squamous cell carcinoma. The hallmark of the disease is spontaneous resolution after an intermediary stationary stage. The majority of the cases is treated by surgical excision. For this reason, very few cases have been documented until resolution, which constitutes the gold standard for this clinic diagnosis. The aim of this article is to report a case of keratoacanthoma in the inferior lip of an immunosuppressed patient.

Squamous cell carcinoma of the lower lip: FAS/FASL expression, lymphocyte subtypes and outcome

Squamous cell carcinoma (SCC) of the lip is a relatively common malignancy of the head and neck region. Tumour thickness, grading and perineural invasion are significant prognostic indicators. However, there is still the need of new reliable biological markers able to predict the prognosis of the single cases with an unfavourable biological behaviour unpredictable by the classic clinical-pathological parameters. 32 cases of (SCC) of the lower lip were analysed for their clincopathologic features, and immunohistochemical expression of Fas/FasL in neoplastic cells and in inflammatory infiltrate. Moreover the density and phenotype of tumour-infiltrating lymphocytes (TIL) were analysed. The results were related with the follow-up of the patients ranging from 2 to 6 years. The cases with over-expression of Fas/FasL in neoplastic cells and Fas+ in T cells preferentially showed a more aggressive clinical behaviour (P<0.01). Moreover we found an alteration of the normal expression of CD4 and CD8 lymphocyte types in ten cases. This data suggest that the Fas/FasL pathway is involved in the close relation between neoplastic cells and T cells and so in the biological behaviour of these tumours.

[Effects of thermochemotherapy on immunologic function of patients with lip cancer]

OBJECTIVE

To evaluate the effects of thermochemotherapy on the immunologic function of lip cancer patients and to provide a theoretical basis for the clinical application of thermochemotherapy.

METHODS

Twenty patients were heated by microwave at (42.5 +/- 0.2) degree C for 40 minutes after venoclysis of Pingyangmycin (8 mg) and Methotrexate (20 mg). Each of the patients received the therapy twice a week for 5 weeks. Venous blood was obtained before the first thermochemotherapy and after the tenth thermochemotherapy. Lymphocyte transformation index was examined by 3H-TdR method, and CD4+ and CD8+ T cells were assayed by flow cytometry.

RESULTS

The tumors of the 20 patients were completely extinctive. The lymphocyte transformation index after treatment was significantly higher than that before treatment (P < 0.01). The CD4+ T cells and CD4+/CD8+ after treatment were significantly higher than those before treatment (P < 0.05); the CD8+ T cells after treatment was lower than that before treatment, but there was no statistically significant difference (P > 0.05).

CONCLUSION

Thermochemotherapy can enhance the lip cancer patient's T lymphocyte immunologic function, which possibly plays an important role in the treatment of lip cancer.

[Tumors of the face in organ transplant patients]

BACKGROUND

The greatly enhanced risk of developing pre-cancerous lesions, basal cell carcinomas, and squamous cell carcinomas in organ transplant recipients is demonstrated on the basis of three of our own cases.

DISCUSSION

Immunosuppression is discussed as the primary reason for enhanced tumour incidence and the occurrence of multiple synchronic and metachronic tumours after organ transplantation. UV exposition and oncogenic viruses must be taken into account as further factors for tumour disposition. More aggressive tumour behaviour has to be expected. In consequence, a focused clinical monitoring and a stringent therapy of the skin tumours is absolutely necessary.

Systemic Hodgkin's lymphoma in a patient with Sézary syndrome

We report a case of a 71-year-old male with Sézary syndrome diagnosed in 1996 who subsequently developed systemic Hodgkin's lymphoma. His only past treatment was bath psoralen plus ultraviolet A. He has since been treated with multiagent chemotherapy (ChlVPP/PABLOE) which induced a remission in his Hodgkin's disease. Eighteen months later he remains in remission from Hodgkin's disease but the Sézary syndrome remains active. He has also developed a squamous cell carcinoma on the upper lip. Sézary syndrome is a primary cutaneous T-cell lymphoma characterized by a malignant proliferation of CD4-positive cells in the skin and peripheral circulation. The CD4 count may be markedly elevated but this results from expansion of a neoplastic T-cell clone and there is a relative lymphopenia of normal T cells leading to a degree of immunoparesis. Immunosuppression is known to be associated with an increased rate of malignancies and this may account for the occurrence of Hodgkin's disease and squamous cell carcinoma in this patient with Sézary syndrome.

Head and neck cancers, but not benign lesions, express interleukin-4 receptors in situ

We have previously reported on the expression of interleukin-4 receptor (IL-4R) on many solid cancer cell lines. In the present study, we have examined the expression of IL-4R on head and neck cancers in situ by immunohistochemistry. Seven primary squamous cell carcinomas of the head and neck region were stained by a monoclonal antibody to human IL-4Rp140 protein (M-57). We report that all squamous cell carcinoma samples were positively stained although at variable intensity with anti-IL-4R antibody. Tumors stained with IgG control did not show any staining. On the other hand, six benign lesions from the same anatomical area showed faint or no staining at all. Three uterine endometrium samples were also negative for the IL-4R expression. In contrast to published contrary results, we did not observe any effect of IL-4 on the proliferation of four squamous cell carcinoma of head and neck (SCCHN) cell lines examined. These results demonstrate that human squamous carcinoma of the head and neck express IL-4R, which could be targeted for diagnosis and therapy by anti-IL-4 receptor antibody fused to toxins or radionuclides or alternatively by IL-4 toxins.

[Simultaneous occurrence of transplantation glomerulopathy, malignant Hodgkin lymphoma and lip cancer in a patient under immunosuppressive treatment]

Authors reported on transplantation glomerulopathy (TGP), occurred in a patient's cadaver kidney allograft, as well as on orchitis, lymphogranulomatosis (Hodgkin's lymphoma) and lip cancer detected thereafter in the same patient. While TGP was definitely be verified morphologically, all other observed diseases are commonly and typically met with membranous glomerulopathy (MGP), which is a separate entity. Similar case has not yet been reported in the literature. Since in majority of the cases the MGP is a paraneoplastic phenomenon, and the TGP is a part of chronic rejection in kidney allografts the differential diagnosis may have therapeutic consequences.

Systemic immunosuppression and oral malignancy: a report of a case and review of the literature

A case is described of squamous cell carcinoma (SCC) of the lower lip in a patient receiving systemic immunosuppression. Contemporary theories on the aetiology of malignancy in such systemically immuno-compromised patients are discussed.

Tumoral infiltrate after local treatment with interferon in squamous cell carcinoma

Using monoclonal antibodies UCHL-1 (T lymphocytes), MT-1 (pan T) and L-26 (B lymphocytes) in the study of the tumoral infiltrate after local treatment with alpha interferon (Roferon) in patients with squamous cell carcinoma of the lower lip, it was observed that: the proportion of UCHL-1 positive cells was between 30% and 80%, the proportion of MT-1 positive cells was of 85% and that of the L-26 positive cells was of 30% of all the cells in the infiltrate. In the area in which after treatment with interferon the tumoral structures had disappeared, the proportion of T lymphocytes was smaller than in the areas in which the tumoral structures were still present. The therapeutic effect of interferon is due both to the direct effects on the tumoral cell and also to the indirect effects, namely the activation of the cytotoxic T lymphocytes and of other cells in the tumoral infiltrate.

[Significance of intratumoral leukocytes in the local immune reaction in squamous cell carcinoma of the lower lip]

50 cases of squamous cell carcinoma of the lower lip were analyzed histologically. Surgical specimens were examined for presence tumor-infiltrating leukocytes and pattern of stromal invasion. The estimation of the characteristics of local immune reaction was performed at the interface of the tumor and underlying tissues at the site of deepest penetration. As a result, there was a significant inverse correlation between degree of tumor-infiltrating leukocytes and pattern of invasion. Marked of tumor-infiltrating leukocytes is a manifestation of efficiently host immune response to the tumor.

[Squamous cell carcinoma of the lower lip in discoid lupus erythematosus associated with hereditary deficiency of complement 2]

We report on a 48-year-old female patient suffering from lupus erythematosus associated with C2 deficiency, who developed squamous cell carcinoma on a discoid lesion of her lower lip. Vermilionectomy (Langenbec-v. Bruns' technique) resulted in a good cosmetic and functional outcome.

Immunocompetent cell reaction in prognostic evaluation of squamous cell carcinoma of the lip

An intimate interplay between the host factors and the tumour seems to be operative in lip cancer, and is undoubtedly capable of modifying the clinical course of the disease. A series of 70 patients with squamous cell carcinoma of the lip was assessed by light microscopy and using histochemical staining for acid alpha-naphthyl acetate esterase to demonstrate the morphological manifestations of tumour-host reactivity. The factors analysed include stromal reactions; intensity of the immunocompetent cell infiltrate including mast cells, and the subpopulations, i.e. B or T lymphocytes and mononuclear phagocytes (MPS cells). B lymphocytes far outnumbered the T and MPS cells in all the infiltrates studied, the percentages of the latter two cell types being inversely related to the intensity of the infiltrate, however. The cell composition in the infiltrates lacked statistically demonstrable effect on the frequency of metastases and the 5-year survival, as did the stromal mast cell reaction, too.

Tumor differentiation and tumor-host interactions as prognostic determinants in squamous cell carcinoma of the lip

A series of 70 patients with the squamous cell carcinoma of the lip and followed-up for at least 5 years, was assessed on light microscopy and using histochemical staining for ANAE (acid-naphthyl acetate esterase) to demonstrate the morphological manifestations of tumor-host reactivity. The factors analysed include cancer differentiation (intrinsic malignancy) and stromal reactions (intensity of the immunocompetent cell infiltrate including the mast cells and the subpopulations, i.e. B- or T lymphocytes or mononuclear phagocytes). Differentiation of the lip cancer was shown to be directly (although not statistically significantly) related to the 5-year survival, as was also the intensity of the stromal immunocompetent cell infiltration. Cancer metastases were evidently the most powerful prognostic determinants, their development being influenced both by the intensity of the stromal immunocompetent cell infiltrate and cancer differentiation. B lymphocytes far outnumbered the T and MPS cells in all the infiltrates studied, the percentages of the latter two cell types, however, being inversely related to the intensity of the infiltrate. The cell composition in the infiltrates was seemingly without effect on the frequency of metastases and the 5-year survival, as was the stromal mast cell reaction, too. It was concluded that analysis of tumor-host relationships using a variety of morphological and immunohistochemical techniques may be of benefit in predicting the clinical course of lip cancer.

[Clinical experiences with the tumor marker TPA in the maxillofacial region]

The tissue polypeptide antigen test (TPA) was carried out in 25 patients with tumours of the maxillofacial region before and after surgery. Further control determination were performed for up to 14 months. A decrease in TPA values was found in only 4 patients after surgery, but a steep rise in TPA values was found with progressive tumor growth. No conclusion can yet be drawn from these initial results as to whether this test is of importance in tumours of the maxillofacial region.

Immunosuppression and the development of malignancies of the upper airway and related structures

In the general population, 90% of the malignancies developing in the upper respiratory tract are squamous cell carcinomas. Analysis of 1081 neoplasms in 1023 renal transplant patients reported to the Denver Transplant Tumor Registry indicates that squamous cell carcinoma remains the predominant malignancy which develops in the upper respiratory tract of immunosuppressed individuals. Comparing the incidence of cancers of the oral cavity (excluding lip cancers) in the immunosuppressed population with the general population it is rather similar (3.5% vs. 4%). When lip cancers are included, one sees a great excess of tumors developing in transplant patients (15% vs. 4.6%). Thus the excess of head an neck epithelial malignancies among these patients is confined to neoplasms of the lip. Examination of the 25 patients reported in this study reveals an unusually young age of the patients, the average age being 41.8 years compared with the general population where most head an neck tumors occur in the 55-65 age group. The average time post-transplantation when cancer developed was 5.3 years, supporting the concept that the more effective the immunosuppressive regimen for prevention of graft rejection, the greater the susceptibility for the development of cancer. Since 90% of transplant patients have serological or clinical evidence of active herpes virus infection, it is possible that this microorganism may play a role in the development of certain head and neck malignancies, especially those involving the lips.

Effect of a bleomycin derivative on oral carcinoma. A clinical and immunologic study of five cases

A new bleomycin derivative NK631 was administered in five cases of advanced recurrent oral carcinoma. The visible improvement of the tumor was noted in three cases, and in the cases of lower lip carcinoma the tumor completely disappeared, however, there was no effective change in cases of cervical metastases of the floor of the mouth and tongue carcinoma. The peripheral lymphocyte counts and serum proteins disclosed a characteristic decrease, serum proteins decreased in the albumin fraction and slightly increased in alpha 2-globlin fraction. Main side effects of NK 631 were skin exanthema, alopecia, anorexia, pyrexia, fatigue and bleeding from the tumor lesion. Regarding the lung function, the vital capacity did not change, but PaO and PaCO in blood gas analysis were together observed to slightly decrease, and it may be supposed that the influence of NK631 on the lung function cannot be neglected. T-cell ratio, lymphocyte blastoformation following PHA stimulation, PPD and DNCB skin tests, and phagocytosis test of peripheral leucocytes were studied. The immuno-suppressive effect of KK631 was the same or weak as bleomycin.

Soluble membrane antigens of lip and cervical carcinomas: reactivity with antibody for herpesvirus nonvirion antigens

With the use of antibody for herpesvirus nonvirion antigens (not structural components of the virus) complement fixing reactivity has been shown for soluble membrane antigens separated from lip and cervical carcinomas but not for similar extracts from normal vaginal tissue or intestinal carcinoma. Neither the serum obtained from the guinea pig before hyperimmunization with the herpesvirus nonvirion antigen nor the antiserum of guinea pigs immunized with comparable uninfected cell extracts reacted with these tumor soluble membrane antigens. Since the above soluble membrane antigens could be specific markers for the presence of virus genome within the tumor cells, the findings could support an etiological role of herpesvirus in selected human malignancies.