Immune thrombocytopenia due to Tranilast (Rizaben): detection of drug-dependent platelet-associated IgG

This study tried to assess the probability of nasopharyngeal carcinoma (NPC) being present in adults with only otitis media with effusion (OME) and evaluate the necessity of nasopharyngeal biopsy in Taiwanese adults with only OME. The clinical features of patients with known OME were analyzed and the incidence of nasopharyngeal carcinoma in adults with only OME was assessed. The clinical features of 36 adults with OME but without other symptoms and signs suggestive of NPC who presented to the Kaohsiung Medical College Hospital Department of Otorhinolaryngology between December 1995 and February 1997 were analyzed. Two of these patients had biopsy-proven non-keratinizing carcinomas. OME was caused by upper respiratory infection in 8 patients (22.2%), chronic paranasal sinusitis in 5 (13.9%), allergic rhinitis in 5 (13.9%), NPC in 2 (5.6%), other etiologies in 5 (13.9%) and by unknown etiologies in 11 (30.5%). The incidence of NPC in adults with OME but no other symptoms and signs suggestive of NPC was 5.6% (2 out of 36 patients). It was higher than other reports because NPC has a high prevalence in Taiwan. Therefore, biopsy of the post-nasal space in adults with only OME when NPC is strongly suspected is necessary for the early diagnosis of NPC in Taiwan. We conclude that Taiwanese adults with only OME for which the cause is unclear should be subjected to an examination and biopsy of the nasopharynx to exclude NPC.     

Pathogenesis of middle-ear effusion in nasopharyngeal carcinoma: a new perspective

The theory that middle-ear effusion (MEE) associated with nasopharyngeal carcinoma (NPC) is merely the result of tensor veli palatinus destruction is deficient because recent studies have shown that many patients with NPC have MEE but no tensor veli palatinus dysfunction. The present study evaluates the relationship between MEE and Eustachian cartilage erosion by NPC and examines the pathogenesis of NPC-associated MEE from a new perspective. Thirty-five patients with NPC were studied by magnetic resonance scans taken along the lengths of the Eustachian tubes. Twenty-four patients had tumour involvement of both sides of the nasopharynx so that 59 ears were available for study. Eighteen ears had MEE of which 12 had Eustachian cartilage erosion (p < 0.00001), Fischer's Exact Test). In ears with MEE, Eustachian cartilage erosion was frequently but not necessarily associated with tensor veli palatinus destruction. We postulate that altered Eustachian tubal compliance as a result of cartilage erosion by tumour is an important reason why middle-ear effusions develop in patients with NPC.     

Current knowledge of Chlamydia pneumoniae and atherosclerosis

Tc-99m tetrofosmin SPECT imaging of the head and neck was performed on 10 patients with nasopharyngeal carcinoma (NPC) and 10 controls. There was no abnormal nasopharyngeal uptake of tetrofosmin in the 10 controls. In the patients with NPC, 3/10 (30%) of the cases had no abnormal uptake and 7/10 (70%) had increased nasopharyngeal uptake. Considering our preliminary study, we find that Tc-99m tetrofosmin SPECT of the head and neck may be helpful in the detection of NPC. However, further study with a larger number of patients is needed to ascertain the value of Tc-99m tetrofosmin SPECT in such cases.     

Lymphoepithelioma-like carcinoma of the renal pelvis: a case report with immunohistochemical analysis and in situ hybridization for the Epstein-Barr viral genome

Lymphoepithelial carcinoma is a relatively common malignancy in the nasopharynx, but it rarely occurs at other sites. Described herein is the first case of a renal pelvic neoplasm that closely resembled lymphoepithelial carcinoma, with analyses of histology, immunophenotype, in situ hybridization for the Epstein-Barr viral genome, and flow cytometric DNA ploidy. The tumor was detected in an 70-year-old Japanese man who presented with hematuria Histologic examination showed an undifferentiated round or spindle cell carcinoma (cytokeratin 7+, cytokeratin 20+, epithelial membrane antigen+, vimentin-) with abundant lymphocytes (predominantly UCHL-1+ T cells), plasma cells, and macrophages in and around the tumor cell nests. The tumor was limited to the pelvis, with a minute focus of carcinoma in situ. No Epstein-Barr viral genomic sequences were detected by in situ hybridization. The tumor had an aneuploid DNA content. The patient remains well without disease 6 years after surgery and radiotherapy. Recognition of this type of renal pelvis carcinoma is important to avoid misdiagnosis.     

Bordetella pertussis diagnosed by polymerase chain reaction

The object of this work was to test the polymerase chain reaction (PCR) for demonstration of Bordetella pertussis (BP) in nasopharyngeal secretions. The method was applied to patients with recently diagnosed pertussis, as verified by BP culture. In order to test the sensitivity and specificity of PCR for the diagnosis of BP, we used known concentrations of BP, Bordetella parapertussis and Bordetella bronchiseptica in aqueous solutions. PCR was furthermore carried out on species of bacteria that might be isolated from the nasopharynx. The applicability of PCR to patient specimens was tested in 25 patients in whose nasopharyngeal secretions BP had been demonstrated after 4-7 days of culture. The detection limit of PCR in aqueous solution was 1-2 BP bacteria per reaction tube. PCR was 100% specific for BP, showing no response with other Bordetella species or other bacteria known to colonize the nasopharynx. Of 25 patient specimens, 16 were PCR-positive 4-7 days after the positive primary culture had been established; only 5 out of 13 patient specimens were positive by repeated conventional nasopharyngeal culture at that time. We conclude that PCR is a possible alternative to culture for the demonstration of BP, as PCR is considerably faster than culture and might be more sensitive.     

Atlantoaxial instability complicating radiation therapy for recurrent nasopharyngeal carcinoma. A case report

STUDY DESIGN: A case report of a patient in whom atlantoaxial instability developed secondary to repeat radiation therapy for recurrent nasopharyngeal carcinoma. OBJECTIVES: To illustrate a dramatic and previously unreported complication of local radiation to the posterior nasopharynx. SUMMARY OF BACKGROUND DATA: Nasopharyngeal carcinoma is an unusual tumor that usually is managed with local, external-beam radiation. It is not thought to involve the cervical spine directly, although local invasion of the skull base is common. METHODS: A review of the medical records and radiographs of the only patient known to develop this complication of radiation used to manage nasopharyngeal carcinoma. RESULTS: Atlantoaxial instability developed in a patient as a result of repeat radiation for a locally recurrent tumor. The instability was associated with intrusion of the anterior arch of C1 into the posterior nasopharynx and was managed successfully with a posterior stabilization using transarticular screws and supplemental wiring. CONCLUSIONS: Patients who have undergone local irradiation for nasopharyngeal carcinoma may be at risk for developing atlantoaxial instability.     

Clinical evaluation of cytological diagnosis of nasopharyngeal malignancies

Between 1970 and 1975 cytological examination was applied to the diagnosis of nasopharyngeal malignancies in a series of 216 consecutive patients who had either a tumour in the nasopharynx or clinical signs of nasopharyngeal carcinoma, or who were locally asymptomatic but had enlarged cervical lymph nodes. Smears were taken by introducing a small rough pad of compressed gauze through the mouth into the nasopharynx with an upward-angled forceps. In each case the cytological smear was taken immediately before biopsy; often, a lymph node was removed subsequently. When morphological diagnoses were doubtful and histological findings were at variance with positive cytological findings, the patients were reexamined clinically, and diagnosis was postponed. The case material was made up of 90 nasopharyngeal carcinomas, 24 lymphomas, one malignant melanoma, one adenoid cystic carcinoma and 100 patients without malignancies. Cytological findings from the first smear were positive in 77.8% of nasopharyngeal carcinomas, in 66.6% of lymphomas and in the cases of melanoma and adenoid cystic carcinoma. There were no false-positive results. When the nasopharyngeal carcinomas were subdivided into undifferentiated carcinomas of the nasopharyngeal type and squamous-cell carcinomas, cytological findings were positive in ,0% and 73%, respectively. Positivity of histological findings was distributed as follows: 91.7% for malignant lymphomas, 86.6% for undifferentiated carcinomas and 86.6% for squamous-cell carcinomas. With respect to clinical suspicion of malignancy, positive cytological findings were obtained in 50% of clinically occult cases and in 84.6% of patients with obvious malignancies; intermediate figures were found for clinically doubtful (64.3%) and for highly suspicious (77.8%) cases. Cyto-histological concordance was shown in 70% of cases; false-negative histological results were obtained in 7.8% and false-negative cytological results in 16.6% of cases. Combined cyto-histological positive results allowed diagnostic accuracy from the first samples in 94.4% of cases. Undifferentiated carcinoma appeared to be the malignancy most accessible to cytological diagnosis, with positive results ranging from 65% in clinically negative or doubtful cases to 84.5% in those with obvious tumours. Assessment of the cytology of the nasopharynx, using the new sampling method described herein, may be a useful diagnostic tool in nasopharyngeal maliganancies.     

Adenovirus-mediated p16 transfer to glioma cells induces G1 arrest and protects from paclitaxel and topotecan: implications for therapy

This study evaluated Epstein-Barr virus (EBV) DNA in sera of 42 patients with nasopharyngeal carcinoma (NPC) and 82 healthy individuals who had been infected previously with EBV. Thirteen of 42 NPC samples were positive for EBV DNA in their sera, whereas all 82 normal controls were negative. In addition, EBV typing between primary tumors and sera showed identical results, suggesting that serum EBV DNA represented tumor DNA. To evaluate the importance of the serum NPC DNA, clinical data and tumor phenotypes including age, sex, WHO type, EBV type, stage, tumor invasion, metastasis, and apoptosis were correlated with serum EBV DNA, and only apoptosis was found statistically significant. In conclusion, EBV DNA was detectable in the serum of some patients with NPC, represented tumor DNA, and might have clinical implications in the future.     

Monitoring response to therapy with thallium-201 and technetium-99m-sestamibi SPECT in nasopharyngeal carcinoma

This study prospectively assessed the value of 201Tl and 99mTc-sestamibi (MIBI) SPECT in monitoring disease regression/progression as compared with MRI findings in patients with nasopharyngeal carcinoma (NPC) having radiotherapy with or without chemotherapy. METHODS: Eighteen patients (age range 15-78 yr, mean 45 yr) had consecutive SPECT imaging using a dual-head gamma camera after the injection of 111 MBq 201Tl and 555 MBq MIBI before therapy and at 3 mo and 6 mo after completion of therapy. A total of 106 SPECT studies was correlated with contemporaneous MRI studies. Tumor-to-background ratios were obtained on coronal slices. Visually detectable lesions in the region of the nasopharynx and cervical lymph nodes were considered positive for residual disease. The gold standard for the presence of disease was the combination of repeat MRI scans, endoscopic examination and clinical evaluation performed 12-15 mo after completion of therapy. RESULTS: MIBI-SPECT proved superior to both 201Tl SPECT and MRI after 3 or 6 mo follow-up in predicting complete response. Accuracy rates in the detection of residual disease in the nasopharynx are 39%, 72% and 89% for MRI, 201Tl and MIBI, respectively, for the 3-mo evaluation; 71%, 71% and 94% for MRI, 201Tl and MIBI, respectively, for the 6-mo evaluation. CONCLUSION: MIBI SPECT could be used as a screening test in predicting response to therapy in patients with NPC.     

Establishment of partial gene expression map of 7q32 in nasopharyngeal carcinoma and primary culture normal nasopharyngeal epithelial cells

OBJECTIVE: To establish partial gene expression map of 7q32 in nasopharyngeal carcinoma (NPC) cell line, tissues and primary culture normal nasopharyngeal epithelial cells. METHODS: We detected the expression of 20 ESTs at 7q32 in NPC cell line HNE1,13 NPC biopsies and primary culture normal nasopharyngeal epithelial cells using differential RT PCR and Northern hybridization. RESULTS: 8 ESTs (AA188181, AA13079,N27556, AA031919, N22721, H20825, T91284, AA001936) expressed equally in both of HNE1 and primary culture normal nasopharyngeal epithelial cells; 7 ESTs (T64215, AA025822, R60014,R80002,H06688, R60192,R95096) expressed in neither of them; 3 ESTs (H19830,W72688,AA130630) overexpressed in HNE1 ; and 2 ESTs (AA070437, H90882) overexpressed in primary culture normal nasopharyngeal epithelial cells. W72688 and H19830 each overexpressed in 77%(10/13) of NPC biopsies; AA070437 down-expressed in 30.7% of NPC biopsies. CONCLUSION: Partial gene expression map of 7q32 in nasopharyngeal carcinoma cell line ,tissues and primary culture normal nasopharyngeal epithelial cells has been established. The up-regulation of W72688, H19830 and down-regulation of AA070437 may be related to the occurrence of NPC.     

Aerobic growth and survival of Campylobacter jejuni in food and stream water

OBJECTIVE: To search differentially expressed sequences correlated with pathogenesis of human nasopharyngeal carcinoma (NPC), including the candidates of tumor suppressor genes. METHODS: cDNA representational difference analysis (RDA) was performed to isolate differentially expressed sequences between cDNA from normal human primary cultures of nasopharyngeal epithelial cells and cDNA from NPC cell line HNE1. The sources of differentially expressed products were proved by Southern blot and Northern blot. The fragments were cloned with pGEM-T easy kit and sequenced by the chain termination reaction. RESULTS: Four differentially expressed cDNA fragments were isolated in the fourth subtractive hybridization using cDNA from normal human primary cultures of nasopharyngeal epithelial cells as tester amplicon and cDNA from NPC cell line HNE1 as driver amplicon by cDNA RDA. These differential cDNA fragments revealed that they really came from the tester amplicon and were not expressed or down-regulated in the NPC HNE1 cells. Of these obtained clones, some are the fragments of the human known genes including house-keeping genes, the others are novel genes. CONCLUSION: NPC involves alteration of multiple genes. Some of known genes matched with the differentially expressed sequences have an effective suppressive ability on the carcinoma.     

EB病毒膜潜伏蛋白LMP-1筛选鼻咽癌的初步结果

Objective: Early diagnosis of nasopharyngeal carcinoma (NPC) is an important method to improve the survival rate. However, the sensitivity and specificity of the screening protocols which was widely used in clinic now are considered to be unsatisfactory. Epstein-Barr virus (EBV)-encoded latent membrane protein-1 (LMP-1)is one of the proteins that have been suggested to be a classic oncogene with transformation properties. The current study set out to discuss the clinical significance of LMP-1 on the screening of NPC. Methods: Three hundred patients who visited our institution (Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou,China) with ENT symptoms between 2007 and 2008 were involved in this study, and all of them were agreed to be involved in this investigation. Not only did they undergo nasopharyngeal swab to obtain cells for the LMP-1 polymerase chain reaction (PCR) analysis, but also nasopharyngeal biopsy were taken to identify the diagnosis. Results: An amount of DNA that was sufficient for PCR was extracted from 243 (81%) swab samples, the positive rate of LMP-1 of those with non-nasopharyngeal carcinoma was 3.85% (4/108), which was much lower than those with nasopharyngeal carcinoma (P ＜ 0.05). By detecting LMP-1 in nasopharyngeal swabs, NPC was diagnosed with a sensitivity of 88.15% (119 of 135 patients), specificity of 96.30%(104 of 108 patients), a positive predictive value of 95.2% (119 of 123 patients), a negative predictive value of 86.67% (104of 120 patients), accuracy of 91.77%, and Youden index of 84.45%. Conclusion: The nasopharyngeal swab coupled with PCR-based EBV LMP-1 detection have high sensitivity and specificity, and also good repeatability, it could serve as part of the screening program for high-risk populations.     

Unusual endocrine presentations of nasopharyngeal carcinoma

BACKGROUND: Nasopharyngeal carcinoma is endemic in Southern China and the majority of patients present with local symptoms due to the tumor. METHODS: This report describes two unusual cases of occult nasopharyngeal carcinoma in which the patients initially presented with endocrine manifestations. RESULTS: The first patient presented with Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) production. Nasolaryngoscopy showed a growth in the left nasal fossa and biopsy revealed a poorly differentiated nasopharyngeal carcinoma that exhibited positive immunostaining for ACTH. The second patient presented with a 10-month history of bone pain over both lower limbs. She was normocalcemic but her serum alkaline phosphatase was markedly elevated. A bone biopsy showed both osteoclastic and osteoblastic activity with widespread fibrosis suggestive of Paget's disease. Three months later, she developed third cranial nerve palsy. Computed tomography investigation revealed a soft tissue mass filling the sphenoid and ethmoid sinuses. Biopsy showed a poorly differentiated nasopharyngeal carcinoma. The bone biopsy was reviewed and immunohistochemistry demonstrated the presence of cells positive for the epithelial marker AE1/3 within the fibrous stroma. Radio-labeled in situ hybridization showed that Epstein-Barr virus early RNA was present in these tumor cells and the bone lesions were in fact metastases. CONCLUSIONS: Nasopharyngeal carcinoma can present with rather atypical symptoms that may lead to a delay in diagnosis. Therefore, in high risk populations, it is important to consider nasopharyngeal carcinoma as a possible primary tumor in patients with occult carcinomas.     

Detection of latent Epstein-Barr virus (EBV) DNA in paraffin sections of nasopharyngeal carcinomas expressing no EBV-encoded small RNAs using in situ PCR

In situ hybridization (ISH) with EBER 1 (Epstein-Barrvirus (EBV)-encoded small RNA1) probes is widely used for in situ detection of EBV-infected cells. ISH with an EBER1 probe showed that 10 of 40 NPC cases were negative for EBER1 expression. For in situ detection of EBV DNA, we used in situ PCR method which can detect one copy of EBV DNA per cell. Of the 10 EBER1-negative cases, three cases including one each of well- and poorly differentiated carcinomas and undifferentiated carcinoma were EBV DNA-positive by in situ PCR. The remaining seven were truly negative for the presence of EBV DNA. All the EBV genome-negative NPC cases examined here were histologically classified as poorly differentiated or undifferentiated carcinomas which are known to be closely associated with EBV, indicating the existence of EBV DNA-negative NPC cases, regardless of histological type or differentiation. These results indicate that there are EBV genome-positive NPC cases expressing no EBER1 and that in situ PCR can be suitable for in situ detection of EBV-infected cells, especially those expressing no EBER1 in paraffin sections.     

Basophil counts on the technicon H*1 automated counter

The authors have conducted a study of 61 cases of nasopharyngeal carcinoma (NPC) with dermatomyositis (DM) admitted to the hospital between April 1964 and May 1989 and accounting for 0.027% (61/226, 183) of all the malignant tumors at the hospital and 0.086% (61/70,899) of the nasopharyngeal carcinoma cases, during that time period. We have analyzed 45 cases with complete data, using equal number of age-, sex-, and stage-matched cases with only NPC as control. The findings show a 5- and 10-year survival rate and distant metastatic rate of 50.4, 34.5, and 40.5% respectively, for NPC with DM, and 57.8, 55.2, and 56.5% for controls. The results indicated that the radiotherapy with prednisone treatment not only is quite effective but also will not result in a significantly increased rate of distant metastasis.     

Undifferentiated carcinoma of nasopharyngeal type of the laryngopharyngeal region

Undifferentiated carcinoma of nasopharyngeal type (lymphoepithelioma) is an extremely rare malignancy in the laryngohypopharyngeal region. We found reports of only 13 such tumors in the English language literature. We present the findings of four additional cases, one hypopharyngeal and three laryngeal in origin. The three laryngeal tumors were characterized by submucosal spread. The tumors were classified T3 (2x) and T4 (2x) with cervical lymph node metastases at initial presentation in all cases. In three of our four cases the Epstein-Barr virus was demonstrated by the Epstein-Barr virus-encoded RNAs in situ hybridization.     

Perspectives on the role of the lateral pterygoid muscle and the sphenomandibular ligament in temporomandibular joint function

This is a phase II study to evaluate the efficacy and toxicity of short-course carboplatin in advanced-stage nasopharyngeal carcinoma (NPC). Thirty-three previously untreated stage III-IV NPC patients were studied. Carboplatin was given as a rapid intravenous injection every 3 weeks. The dose of carboplatin was calculated according to the individual patient's creatinine clearance and desired platelet nadir of 75,000/microliter according to the Egorin formula. Response and toxicity were evaluated. Thirty-two patients were evaluated for response. The median age was 54 years, range 30-70 years. Twenty-four patients had local regional disease and 8 patients had metastatic disease. The median dose of carboplatin given was 415 mg/m2 (range 91-791 mg/m2). Fourteen (44%) patients had a partial response with a 95% confidence interval of 26-62%. Fifteen (47%) patients had stable disease and 3 (9%) progressive disease. The overall median survival rate was not reached at 43 months. Overall toxicity was tolerable. Grade III-IV myelosuppression occurred in 4 (12%) patients. There were no other major toxicity- or treatment-related deaths. We conclude that carboplatin has a significant anticancer effect in advanced NPC. Thus carboplatin combination chemotherapy for the treatment of NPC is worthy of future clinical investigations.     

Anti-interleukin-10 antibodies in patients with chronic active Epstein-Barr virus infection

The Epstein-Barr virus (EBV) genome encodes a protein in its BamHI C restriction fragment rightward open-reading frame-1 (designated BCRF1 or viral interleukin-10 [vIL-10]) that shares protein homology and biologic properties with human IL-10. Several EBV disorders are characterized by prolonged active EBV infection. Because continued EBV replication could allow for increased vIL-10, ELISA and immunoprecipitation were used to determine whether vIL-10 expression during chronic active EBV infection resulted in vIL-10 and IL-10 antibodies. IL-10 antibodies were assayed in patients diagnosed with chronic and acute infectious mononucleosis (CIM, AIM), nasopharyngeal carcinoma (NPC), and EBV-associated lymphoproliferative disease (LPD), as well as from healthy organ transplant patients and EBV-negative or EBV-positive persons. Whether anti-IL-10 antibodies could inhibit IL-10 biologic activity was determined. vIL-10 antibodies were found in CIM, NPC, and LPD patients and antibodies reactive to IL-10 were found in CIM patients. One CIM patient had IL-10 antibodies that neutralized IL-10 bioactivity in vitro.     

Management of the neck in nasopharyngeal carcinoma (NPC)

Management of cervical nodal metastasis from nasopharyngeal carcinoma (NPC) begins with a thorough assessment of the patient to determine extent of the disease process at the primary site, regionally and systematically. Detailed knowledge of the anatomy of the head and neck will facilitate an accurate diagnosis and subsequent staging of each individual patient. The use of the appropriate diagnostic tools such as imaging, fine-needle aspiration studies, and serology direct the clinician to the appropriate management scheme. This article attempts to cull information from various clinicians who treat the majority of NPC patients, and to raise the issue of the need for more innovative approaches.