Single-cell RNA sequencing explores the evolution of the ecosystem from leukoplakia to head and neck squamous cell carcinoma

It has been found that progression from leukoplakia to head and neck squamous cell carcinoma (HNSCC) is a long-term process that may involve changes in the multicellular ecosystem. We acquired scRNA-seq samples information from gene expression omnibus and UCSC Xena database. The BEAM function was used to construct the pseudotime trajectory and analyze the differentially expressed genes in different branches. We used the ssGSEA method to explore the correlation between each cell subgroup and survival time, and obtained the cell subgroup related to prognosis. During the progression from leukoplakia to HNSCC, we found several prognostic cell subgroups, such as AURKB + epithelial cells, SFRP1 + fibroblasts, SLC7A8 + macrophages, FCER1A + CD1C + dendritic cells, and TRGC2 + NK/T cells. All cell subgroups had two different fates, one tending to cell proliferation, migration, and enhancement of angiogenesis capacity, and the other tending to inflammatory immune response, leukocyte chemotaxis, and T cell activation. Tumor-promoting genes such as CD163 and CD209 were highly expressed in the myeloid cells, and depletion marker genes such as TIGIT, LAG3 were highly expressed in NK/T cells. Our study may provide a reference for the molecular mechanism of HNSCC and theoretical basis for the development of new therapeutic strategies.

The profile of chronic hyperplastic candidiasis: a clinico-pathological study

The aims of this study were investigation of clinical presentation, systemic factors, and long-term malignant transformation rate in chronic hyperplastic candidiasis versus leukoplakia. This is a retrospective case-controlled study of cases with chronic hyperplastic candidiasis and leukoplakia without dysplasia, diagnosed between 2000 and 2013. A database was created, and all additional biopsies from the same cases were searched up to 2022, for records of oral malignant transformation. Associations between microscopic diagnoses and clinical features of lesions and clinical outcomes of patients were performed. A study database included 116 patients, allocated to the group diagnosed with chronic hyperplastic candidiasis (CHC-group, 62) and to the group of leukoplakia without dysplasia (LKP-group, 54). Tongue and buccal mucosa were most frequently recorded in both groups. In CHC-group, significantly fewer cases presented as white lesions compared to LKP-group (P < 0.001); more were ulcerated or exophytic (P = 0.006 and P = 0.003, respectively). History of head and neck malignancy was significantly more frequent in CHC-group (P = 0.005), as were chemotherapy, (P = 0.019) radiotherapy (P = 0.0265), and immune-related conditions (P = 0.03). Within the follow-up period (2000-2022), in CHC-group, two cases (3.2%) had malignant transformation at the site of original biopsy, one was recurrence of previous carcinoma. In LKP-group, two cases (3.7%) had newly diagnosed carcinoma and one at the site of original biopsy; no significant differences were found between groups. In conclusion, medical background of immune-related conditions, head and neck malignancy, radiotherapy, and chemotherapy may play a role in predisposing for chronic hyperplastic candidiasis. Malignant transformation rate within CHC-group was low, and similar to that within LKP-group, representing a lower transformation rate than expected.

Convolutional neural network-based vocal cord tumor classification technique for home-based self-prescreening purpose

BACKGROUND

In this study, we proposed a deep learning technique that can simultaneously detect suspicious positions of benign vocal cord tumors in laparoscopic images and classify the types of tumors into cysts, granulomas, leukoplakia, nodules and polyps. This technique is useful for simplified home-based self-prescreening purposes to detect the generation of tumors around the vocal cord early in the benign stage.

RESULTS

We implemented four convolutional neural network (CNN) models (two Mask R-CNNs, Yolo V4, and a single-shot detector) that were trained, validated and tested using 2183 laryngoscopic images. The experimental results demonstrated that among the four applied models, Yolo V4 showed the highest F1-score for all tumor types (0.7664, cyst; 0.9875, granuloma; 0.8214, leukoplakia; 0.8119, nodule; and 0.8271, polyp). The model with the lowest false-negative rate was different for each tumor type (Yolo V4 for cysts/granulomas and Mask R-CNN for leukoplakia/nodules/polyps). In addition, the embedded-operated Yolo V4 model showed an approximately equivalent F1-score (0.8529) to that of the computer-operated Yolo-4 model (0.8683).

CONCLUSIONS

Based on these results, we conclude that the proposed deep-learning-based home screening techniques have the potential to aid in the early detection of tumors around the vocal cord and can improve the long-term survival of patients with vocal cord tumors.

Difficult glottis: Diagnostic dilemma in viewof the clinical presentation

<br><b>Introduction:</b> The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. However, we observe rare cases when numerous pathologies overlap, resulting in an unclear and complicated clinical presentation of the glottis.</br> <br><b>Aim:</b> The aim of this paper is to present cases of overlapping etiopathological factors which poses a challenge when making a diagnosis and referring a patient for adequate treatment.</br> <br><b>Material and method:</b> The study presents different photographs of the glottis, including some unique and unusual images in which overlapping pathologies were captured. The photographs are accompanied by case descriptions, comments, and pathological analyses.</br> <br><b>Results:</b> Four selected photographs showed a bunch of exophytic growth lesions with foci of whitish plaques, covered by yellowish crusts, with thinned, reddened vocal folds presenting foci of leukoplakia. The study discussed possible causes of vocal folds edema, diffuse erythema, presence of crusts or exudate, whitish debris/plaques or development of leukoplakia, non-neoplastic ulceration, as well as injected and reddened mucous membrane. Chronic infectious laryngitis, idiopathic ulcerative laryngitis, and drug-induced laryngitis were also mentioned. The study also raised the issues concerning diabetics and patients treated with inhaled corticosteroids, including candidiasis and primary aspergillosis of the larynx.</br> <br><b>Conclusions:</b> To conclude, everyday clinical practice involves encountering cases of unclear onset and course, with complicated presentation of the glottis. Therefore, comprehensive history-taking and thorough investigation of systemic causes are of immense importance. Recommended management includes conducting the most meticulous differential diagnosis, implementing treatment for the most likely cause, and, whenever possible, refraining from biopsy in order to avoid permanent damage to vocal cords.</br>.

Assessment of brush biopsy findings and salivary LDH levels in oral mucosal lesions of tobacco users

Introduction

The oral brush cytology is an alternative method developed to improve the efficacy of conventional cytology in oral potentially malignant disorder (OPMD), and salivary lactate dehydrogenase (LDH) which is a cytoplasmic enzyme has been widely used as a marker for diagnosing various diseases. The purpose of the study is to evaluate the brush biopsy findings and salivary LDH levels for the early diagnosis of premalignant and malignant lesions of the oral cavity.

Materials and Methods

Patients with deleterious habits including tobacco-related lesions such as leukoplakia, tobacco pouch keratosis, and oral cancer were included in the study. For each patient, saliva sample was collected, brush biopsy was done and smears were prepared. Collected saliva samples were analysed for salivary LDH levels and prepared smears were analysed for dysplastic changes and statistical analysis was performed.

Results

Out of 80 samples, 30 were leukoplakia, 45 were tobacco pouch keratosis and 5 were oral cancer, and 13 samples showed positive dysplastic changes, 26 samples showed atypical dysplastic changes and 41 samples showed no signs of dysplastic changes and concluded as negative. On comparing the results of brush biopsy findings and salivary LDH levels, the mean salivary LDH value for positive dysplasia was elevated and the P value was statistically significant (P value: 0.00).

Conclusion

Brush biopsy showed good potential in detecting premalignant lesions and salivary LDH levels showed a marked increase which can be used as a diagnostic biomarker and serve as a potent diagnostic aid for early detection of malignancy.

Single-cell transcriptome profiling of the stepwise progression of head and neck cancer

Head and neck squamous cell carcinoma (HNSCC) undergoes stepwise progression from normal tissues to precancerous leukoplakia, primary HNSCC, and metastasized tumors. To delineate the heterogeneity of tumor cells and their interactions during the progression of HNSCC, we employ single-cell RNA-seq profiling for normal to metastasized tumors. We can identify the carcinoma in situ cells in leukoplakia lesions that are not detected by pathological examination. In addition, we identify the cell type subsets of the Galectin 7B (LGALS7B)-expressing malignant cells and CXCL8-expressing fibroblasts, demonstrating that their abundance in tumor tissue is associated with unfavorable prognostic outcomes. We also demonstrate the interdependent ligand-receptor interaction of COL1A1 and CD44 between fibroblasts and malignant cells, facilitating HNSCC progression. Furthermore, we report that the regulatory T cells in leukoplakia and HNSCC tissues express LAIR2, providing a favorable environment for tumor growth. Taken together, our results update the pathobiological insights into cell-cell interactions during the stepwise progression of HNSCCs.

The Taq 1 polymorphism of Vitamin D receptor gene is associated with oral cancer and preoral cancer in North Indian population

BACKGROUND

Oral cancer is known as one of the most common cancers, with a poor prognosis, related to delayed clinical diagnosis, either due to the lack of particular biomarkers related to the disease or costly therapeutic alternatives.

AIMS AND OBJECTIVES

In this study association of single nucleotide polymorphism (Taq1, T>C) in Vitamin D receptor gene with oral cancer and pre oral cancer was studied.

MATERIALS AND METHODS

Total 230 patients of precancerous oral lesions (Leukoplakia 70, Oral Sub mucous fibrosis 90, Lichen Planus 70), 72 oral cancer patients and 300 healthy control subjects were genotyped by PCR-RFLP methods. Chi-square test was used for calculation of genotype and allele frequencies.

RESULTS

Mutant genotype CC as well as C allele were found to significantly decrease the risk of oral disease (P value=0.04, OR=0.60 and P value=0.02, OR=0.75 respectively). In particular, compared to non smokers, smokers with TC & CC genotypes were at decrease risk of oral diseases (P value=0.0001, OR=0.04). The mutant allele genotype CC as well as the mutant allele C showed protective association with leukoplakia (P value=0.01, OR=0.39 & P value=0.009, OR=0.59 respectively). However, individual with CC genotype had developed high cell differentiated grade at diagnosis (OR= 3.78, P value= 0.008).

CONCLUSIONS

This study concludes that VDR (Taq1) polymorphism is associated with oral cancer and pre oral cancer susceptibility in North Indian population.

[Features of molecular genetic diagnosis of verrucous leukoplakia]

OBJECTIVE

To evaluate the initial molecular genetic signs of malignancy of verrucous leukoplakia (VL).

MATERIALS AND METHODS

The study of VL was carried out on biopsies of 21 patients with the diagnoses of verrucous hyperplasia (VH) (15 cases - 71.4%) and verrucous carcinoma (VC) (6 cases - 28.5%). Tissue antigens were determined using mouse monoclonal antibodies to the Ki-67 protein (MM1, Diagnostic Biosystems). Telomerase activity was determined using rabbit immunoglobulin (TRT, Abbiotec). The amplification of the TERC (Telomerase RNA Component) portion of the RNA of the third chromosome was studied by the FISH method.

RESULTS

In the studied groups, high cell proliferation and significant differences between HC and VC were revealed. The amplification of TERC by the FISH method made it possible to carry out differential diagnostics between VG and VC. According to the results of the study, the amplification of the TERC gene was detected in 100% in VC and in 20% in VG.

CONCLUSION

The FISH method makes it possible to detect VL malignancy at an early stage. Amplification of the TERC gene is characteristic of malignant transformation of epithelial cells in VC. In IG, as a rule, there was no amplification, which can serve as evidence of the benign nature of the pathology of COP.

Cancer-associated fibroblast-like fibroblasts in vocal fold leukoplakia suppress CD8+T cell functions by inducing IL-6 autocrine loop and interacting with Th17 cells

The characteristics of fibroblast cells in head and neck precancerous lesion and its ability to secrete inflammatory cytokines and affect CD8⁺T cell functions remain unclear. Herein, we reported the existence of fibroblasts in human-derived vocal fold leukoplakia (VFL) with positive staining of fibroblast activation protein (FAP) and α-smooth muscle actin (α-SMA). The fibroblasts from VFL and cancer-associated fibroblasts (CAFs) from head and neck squamous cell carcinoma (HNSCC) displayed similar cellular functions and robust inflammatory cytokine secretions. The effects of fibroblasts from VFL in inducing the apoptosis, depletion of CD8⁺ T cells and recruitment of regulatory T cells (Treg cells) were observed. We further assessed the autocrine loop within VFL fibroblasts to self-stimulate by secreting IL-6, TGF-β through the IL-6/JAK2/STAT3 pathway. The synergistic stimulation of IL-6 and TGF-β promoted Th17 cell differentiation and IL-17A secretion, which could result in fibroblast activation in another positive loop. Tocilizumab (TOC), a monoclonal antibody targeting IL-6R, managed to suppress the overexpression of both IL-6 and TGF-β in VFL fibroblasts, and thus blocking IL-6 autocrine loop and CAF-Th17 loop in vitro. In a murine model of oral leukoplakia (OL), local injection of TOC inhibited the outgrowth of lesions and showed notable effect in control of OL progression in vivo. Our findings establish a novel rationale for blocking the IL-6/JAK2/STAT3 pathway to inhibit vocal fold (oral) leukoplakia progression and postpone HNSCC tumorigenesis.

[Application of deep learning assisted electronic laryngoscope in diagnosis of laryngeal leukoplakia]

In recent years, medical imaging technology and computer technology have made great progress. On the one hand, with the development and popularization of electronic laryngoscope, the image of electronic laryngoscope plays a very important role in the diagnosis of vocal cord lesions. On the other hand, deep learning algorithm，especially convolutional neural networkhas gradually become the first choice of medical image recognition since the foundation of deep learning algorithm. So far, deep learning algorithm has made great contributions in many disciplines. In this paper, the basic concept of deep learning, the current status of image recognition of vocal cord lesions, and the prospect of research based on deep learning in vocal cord image lesions recognition are reviewed.

[Clinical diagnosis and treatment of 157 cases of vocal leukoplakia]

Objective:To study the clinical characteristics and common etiology of vocal cord leukoplakia, and explore the treatment principle. Method:One hundred and fifty-seven patients with vocal cord leukoplakia were recruited in this study. They were assessed by routine laryngoscope, narrow band imaging （NBI）, stroboscope, reflux finding score （RFs） and reflux symptom index （RSI）, and given conservative treatment （smoking cessation, alcohol, acid suppression, sound cessation, etc.） and/or surgical treatment. Result:Among 157 patients with leukoplakia of vocal cord, 109 （69.4%） had basically improved or cured after conservative treatment. Forty-eight cases underwent operation. The postoperative pathological diagnosis was mild dysplasia in 2 cases （1.3%）, moderate dysplasia in 15 cases （9.6%）, severe dysplasia or carcinoma in situ in 19 cases （12.1%）, and invasive carcinoma in 12 cases （7.6%）. Conclusion:NBI and stroboscopic laryngoscopy showed that most of the leukoplakia of vocal cord was non-malignant in nature, which was not in accordance with the indication of operation. Conservative treatment is effective. Biopsy or operation was indicated in only a few patients. Moreover, most of the patients are accompanied by laryngopharyngeal reflux, and the treatment of acid suppression is effective.

Olmsted syndrome

Olmsted syndrome is a rare disorder characterized by symmetrical sharply marginated mutilating keratoderma of palms & soles & hyperkeratotic plaques around the body orifices, onychodystrophy, ainhum & amputation of digital phalanges, flextion deformities of the fingers, localized alopecia, leukokeratosis of the tongue, shortness of stature & laxity of large joints. Inheritance is autosomal dominant, although sporadic cases have been reported. Here we describe two cases of this rare disorder with thickened hyperkeratotic lesion over palm & soles & along with amputation of 3rd , 4th & 5th toes in one case. In one of our case (case no. 2) the immediate younger brother has got the same disease. Both of them were treated with tab. Neotegason 25 mg orally daily for 3 months & there was significant improvement after treatment.

Pachyonychia congenita associated with steatocystoma multiplex

We present an unique case of pachyonychia congenita associated with steatocystoma multiplex. A 33-year-old Japanese man had thickening and gray-brown dicoloration of all nails and a large number of nodules or tumors over his entire skin. No palmar and plantar hyperkeratosis, leukokeratosis of the mucous membranes, or follicular keratosis were observed. Histology of these tumors revealed the typical features of steatocystoma multiplex.

Some dental problems and the surgeon

Images

Carcinoma of the vulva

A series of 127 patients presenting at two London hospitals with carcinoma of the vulva during the period 1948-70 is reviewed. Patients with intraepithelial carcinoma or rodent ulcer are excluded, but the series includes two cases of malignant melanoma, one of adenocarcinoma of Bartholin's gland, and two of basal cell carcinoma. In the remainder the pathological diagnosis was squamous cell carcinoma.Leucoplakia was present in only 30 cases (24%) and it is therefore concluded that this condition is probably not so dangerous as a precursor of cancer as has been stated in the past, though an association with cancer of the vulva is undeniable.In only three cases was no form of treatment practicable. Of the remaining 124, two were treated by radiotherapy, 37 by simple vulvectomy, 12 by vulvectomy followed by separate inguinal lymphadenectomy, and 73 by radical vulvectomy combined with bilateral lymphadenectomy en bloc, pelvic lymphadenectomy being included whenever the superficial lymph nodes appeared to be involved or when Cloquet's node was shown by frozen-section examination to be invaded. Excellent results, with an absolute five-year survival rate of 66%, were obtained with this last procedure, especially when primary skin cover was provided by the delayed technique (five-year survival 73%). The results of simple vulvectomy were also surprisingly good, with an absolute five-year survival rate of 65%, and this operation may be a wise choice for the very old or infirm patient.