upper aerodigestive tract

A cross-sectional study was conducted in the outpatient department of ENT, at Chamarajanagar Institute of Medical Sciences and Hospital, Chamarajanagar, India, for a period of 1 year 10 months from October 2014 to July 2016. 100 patients who were diagnosed as having upper aerodigestive tract malignancy by histopathology were included in the study group. A detailed history was taken and clinical examination including ear, nose, throat, neck, general and systemic examination was carried out in all patients suspected to be having upper aerodigestive tract malignancy. FNAC (Fine Needle Aspiration Cytology) of neck masses if present was carried out. Complete haematological evaluation was carried out. Specialized investigations like upper gastro-intestinal endoscopy, computerized tomography (CT), MRI (magnetic resonance imaging) of the head and neck region, diagnostic imaging of chest and abdomen was carried out if required. Direct laryngoscopy and hypopharyngoscopy was carried out and tissue specimen obtained by biopsy of the growth in various parts of the upper aerodigestive tract. Biopsy specimen of lesions in the oral cavity was taken by direct visualization of oral cavity. The specimen were sent for histopathological

A variety of imaging methods, such as com- puted tomography (CT), magnetic resonance (MR) imaging, and positron emission tomogra- phy (PET), have been used to study patients with squamous cell carcinoma of the upper aerodigestive tract. Recently, proton MR spec- troscopy has been used to help characterize malignant neoplasms, including various brain tumors, gynecologic tumors, and lymphomas (1–3). Proton MR spectroscopy provides a non- invasive method for evaluating the metabolic components of the soft tissues of the neck. Be- cause proton MR spectroscopy measures the presence of specific metabolites and is not de- pendent on anatomic information, this tech- nique has the potential to show malignant tu-

The upper-aerodigestive tract (UADT) comprises of nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, trachea. Upper- aerodigestive tract tumors forms 4% of all malignancies. Squamous cell carcinoma(SCC) is the common tumor, with male : female ratio of 3:1. Common risk factors are smoking, tobacco and alcohol consumption. Human Papilloma Virus (HPV) is a newly diagnosed risk factor and it is mostly seen in absence of other risk factors. HPV associated SCCs of upperaerodigestive tract is seen in a unique population of patients, i.e they are younger in age compared to the conventional SCC and these tumors have characteristic histopathological feature : They are non – keratinizing basaloid appearing tumors with necrosis and palisading seen in areas. These also have better response to treatment than the conventional SCC.

OSAS caused by upper aerodigestive tract tumors (ADTTs) has been rarely reported in large series; they have been documented most- ly in case reports. Payne et al. reported that OSAS was presented in 13 of 17 patients (76%) with malignancies of the oral cavity and oro- pharynx. In our series, we found that, in nine consecutive patients, upper ADTTs were asso- ciated with OSAS lasting over 10 years, except common head-and-neck squamous cell carci- noma, including carcinomas of the nasophar- ynx, oropharynx, hypopharynx and larynx. Additionally, all of the patients were male. AHI was from 15 to 80 (average, 41.2). The most common symptom was sudden aggravation of snoring or gasping (cases 1, 3, 4, 6, and 7). Thus, we suggested that OSAS caused by head- and-neck tumors should be considered, and further examinations should be performed, including routine workup (CT and MRI) and PET/ CT. In our series, case 1 was initially diagnosed with OSAS lasting over 10 years in January 2005 and underwent UPPP surgery. After sur- gery, the snoring symptom was suddenly aggra- vated. CT of the head and neck showed a mass in the left parapharyngeal space. Nine years later, his symptoms also included sudden breath apnea. CT and MRI revealed recurrence of a pleomorphic adenoma in the left parapha- ryngeal space. Case 3 had been diagnosed with OSAS lasting over 20 years, and snoring became suddenly aggravated 2 months prior. PET/CT showed high FDG uptake in the naso- pharynx and bilateral cervical lymph node, which suggested malignancy. A biopsy of the nasopharynx demonstrated DLBCL. Case 4 also presented with sudden snoring and apnea for 1 month. Nasendoscopy and CT showed mucosal thickening in the nasopharynx. However, the nasopharynx biopsy showed no evidence of malignancy. PET/CT revealed high FDG uptake in the nasopharynx, bilateral pala- tine tonsil, and multiple cervical lymph nodes. These findings also suggested malignancy at these sites. Right tonsillectomy was performed, and the pathological results demonstrated mantle cell lymphoma. Case 6 was diagnosed with OSAS lasting over 1 year. UPPP surgery was suggested, but the patient refused it. He was admitted to our department due to symp- toms of sudden snoring and apnea lasting for over half a year. He underwent UPPP surgery; however, the postoperative pathological results

Immune response is known to develop against malignant tumours. Malignant tumours express newer antigen on their cell surface membrane which elicit immunological reaction in and around tumoural tissue. In early part of immune reaction neutrophil, eosinophil migrates followed by monocyte-macrophage cell. Tumor associated tissue eosinophilia (TATE) is believed to play a sig- nificant role in the biological behavior of the carcinoma. Eosinophil infiltrate in association with the head and neck squamous cell carcinoma (SCC) have been reviewed from time-to-time. The sig- nificance of such an association has been variably thought to be either a potential diagnostic tool for stromal invasion or as a prognostic indicator. The aim of this study was to investigate and evaluate the possible role of the tumour associated tissue eosinophilia (TATE) as a predictive in- dicator for the grading and establishing prognosis of the upper aerodigestive tract squamous cell carcinoma (SCC).

We have included a predominantly male population (male-female, 9:1) and a larger number of patients with stage IV tumors than with stage III tumors (stage IV-III, 4:1). The predominantly male patient population of the study nearly reflected the higher incidence of upper aerodigestive tract SCCA for men than women that is estimated by the American Cancer Society 20 and is reported in the literature. 21 Patients were consecutively enrolled as they presented if they met in- clusion criteria (clinical stages III-IVA-B SCCA) of the clinical study, of which the present investigation is a part. The lack of patients with stages I-II tumor did not allow comparison of perfusion parameters between different clinical stages. The in- clusion of patients exclusively with advanced-stage tumor, which may present with necrotic areas and, then, with proba- bly higher perfusion heterogeneity than tumors in early stages, may have potentially led into an overestimation of both the inter- and intraobserver variability for CTP measurements. Study results, then, may only apply for a similar patient population.

Seventeen patients with advanced (stage III and IV) squamous cell carcinoma of the upper aerodigestive tract were enrolled in a prospec- tive trial in which response to neoadjuvant chemotherapy was as- sessed. Inclusion criteria for this study were: pathologically proved squamous cell carcinoma of the upper aerodigestive tract staged ac- cording to the American Joint Committee on Cancer criteria, no ev- idence of distant metastatic disease, a chest CT documenting no evi- dence of a second primary malignancy, a surgically resectable tumor, white blood cell count ⱖ 3500/mm 3 , platelet count ⱖ 100,000/mm 3 ,

Foreign bodies in the upper aerodigestive tract are a common clinical problem in otolaryngological practice as evident in this study. Symptoms of foreign bodies in the aerodigestive tract are mainly non-specific and needs high degree of suspicion, experience and clinical acumen. Signs are also variable from case to case and inconstant in a particular case. However the only single reliable factor is a positive history which often is not contributory in spite of careful and tactful attempt to elicit it and particularly in children where it goes unnoticed. An orderly and systematic approach along with proper history and clinical examination is keystone in diagnosis and early management.

T-lymphoblastic lymphoma is a high-grade malignant lymphoma characterized by an immature T-precursor phenotype, occurrence in male adolescents, and high incidence of mediastinalinvolvement [1]. It closely related to T-cell acute lymphoblastic leukemia; indolent T-lymphoblastic proliferations are not generally recognized to occur [1]. Velanker [2] and his team firstly reported an indolent T-lymphoblastic proliferation in 1999. The patient had an over 16-year history of T-lymphoblastic proliferation located at the upper aerodigestive tract with frequent recurrences but without evidence of systemic dissemination. The patient only received surgical resection but not received chemotherapy or radiation therapy. Since then nearly 10 detailed case reports of indolent T-lymphoblastic proliferation have been noted in the literature with increasing frequency in recent years [3]. Robert S. Ohgami [3] and his team had summarized specific criteria used to diagnose indolent T-lymphoblastic prolifera- tion, notably: (1) Confluent groups of TdT + T

8 smoking at diagnosis and 3,092 (7·3%) had stopped smoking within three years of diagnosis There were 159,182 people diagnosed with CHD during this period, of whom 28,987 (18·2%) smoked at diagnosis and 6,301 (4·0%) had stopped smoking within three years of diagnosis. Of these groups, 12,393 cancer cases were successfully matched to the same number of CHD controls and were included in the main analyses. There were 9,347 people with lung cancer (86% current smokers), 2,050 with bladder cancer (90% current smokers), with upper aerodigestive tract cancers (91% current smokers). Sensitivity analyses of people who had survived for at least one year, included 5,094 incident cancer cases (2,781 lung, 1,512 bladder, 801 upper aerodigestive) and 5,094 matched CHD controls.

Foreign bodies (FBs) in the upper aerodigestive tract are emergency situations and present a challenge to the Otorhinolaryngologist. Though it is more commonly seen in children, no age group is completely immune. The larynx performs an effective sphincteric action to protect the lower airways and it is unusual for to get aspirated rather than swallowed. Most of the cases of FB ingestion reported in literature were associated with acute symptoms and the object either courses through the gastrointestinal tract without incident, or requires an

This was a prospective study acquiring data from January 2005 to December 2008 in 102 patients with a primary SCCA of the upper aerodigestive tract who underwent a routine CT study of the head and neck that included a PCT acquisition. Inclusion criteria for the study were as follows: All patients had to be older than 18 years of age and had to have histologically proved primary SCCA of the oropharynx and hypopharynx followed immediately by concomitant chemora- diation and a baseline perfusion study within 1 week before therapy initiation. Exclusion criteria were the following: a prior head or neck malignancy, a history of head or neck irradiation, prior chemother- apy, prior surgical intervention for known malignancy (excluding Received May 25, 2009; accepted after revision July 17.

Gross tumor volume GTV at the primary site, as derived from pretreatment CT findings, can help predict local control of squamous cell carcinoma at different head and neck subsites after [r]

Genome-wide association studies (GWAS) have been successful in identifying common genetic variation involved in susceptibility to etiologically complex disease. We conducted a GWAS to identify common genetic variation involved in susceptibility to upper aero-digestive tract (UADT) cancers. Genome-wide genotyping was carried out using the Illumina HumanHap300 beadchips in 2,091 UADT cancer cases and 3,513 controls from two large European multi-centre UADT cancer studies, as well as 4,821 generic controls. The 19 top-ranked variants were investigated further in an additional 6,514 UADT cancer cases and 7,892 controls of European descent from an additional 13 UADT cancer studies participating in the INHANCE consortium. Five common variants presented evidence for significant association in the combined analysis (p#56 10 27 ). Two novel variants were identified, a 4q21 variant (rs1494961, p = 16 10 28 ) located near DNA repair related genes HEL308 and FAM175A (or Abraxas) and a 12q24 variant (rs4767364, p = 26 10 28 ) located in an extended linkage disequilibrium region that contains multiple genes including the aldehyde dehydrogenase 2 (ALDH2) gene. Three remaining variants are located in the ADH gene cluster and were identified previously in a candidate gene study involving some of these samples. The association between these three variants and UADT cancers was independently replicated in 5,092 UADT cancer cases and 6,794 controls non- overlapping samples presented here (rs1573496-ADH7, p = 56 10 28 ; rs1229984-ADH1B, p = 7 610 29 ; and rs698-ADH1C, p = 0.02). These results implicate two variants at 4q21 and 12q24 and further highlight three ADH variants in UADT cancer susceptibility.

Finally, based on a total of 23 studies, our meta-analysis sug- gested that allele A of the CCND1 G870A polymorphism is associated with SCC development of the UADT, especially among As[r]

complications are potentially catastrophic, including cervical abscess, mediastinitis, esophageal aortic fistula, Oesophago-carotid fistula and lung abscess 1,51 . Fish bones are translucent on physical examination and often radiolucent. They usually lodge in the tonsils, due to the presence of many crypts in which it gets caught 1,4 . It may be present in the posterior one third of tongue or the vallecula. It very rarely crosses these sites. Hence examination of the oral cavity and using an indirect laryngoscopic mirror after spraying an anaesthetic agent will identify the fish bone in majority of instances. The patient most often points to a site of irritation in the throat. If not found, then an endoscopic examination can be carried out and radiological investigation resorted to. Patients complain mostly of a foreign body sensation 51 . A sharp pricking sensation is highly predictive. A complete oral examination is mandatory 51 . Plain films may exhibit poor sensitivity when the bone is lodged in the area of maximum soft tissue overlap. There is also poor specificity because of thyroid, cricoid and hyoid calcifications, which can be misleading. One should not rely on a negative radiograph to rule out a retained bone . All patients who complain of a foreign body in the throat should be taken seriously. The current thinking is that in the absence of a proven retained foreign body, the sensations described are due to minor trauma of the digestive tract that are produced when the bone is swallowed 1,51 . Most of the time, these are removed by forceps under

We adjusted for potential confounders such as deprivation, BMI, smoking, alcohol consumption, medical history and family history of cancer. However the quality of some of this information was poor. For example, there was a large amount of missing data and inconsistency in recording of smoking and alcohol consump- tion. In addition, we did not have information on other risk factors for UADT, such as poor nutrition (especially low fruit and vegetable consumption), history of HPV infection, poor oral hygiene and genetic factors. However, analyses of US healthcare utilisation data sets indicate that these potential confounders have limited influence in studies of NSAID use and various health outcomes (Schneeweiss et al, 2005). Analysis of the relationship between confounding factors and UADT cancer in our study showed similar association. For example, increased risk was associated with increased deprivation (Conway et al, 2010), low BMI (Gaudet et al, 2010), smoking (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 2004) and alcohol consumption (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 2010). We also used multiple imputation to replace the missing values for confounding factors. Systematic review of observation studies of NSAIDs use and upper gastrointestinal tract bleeding and perforation (Herna´ndez- Dı´az and Rodrı´guez, 2000) showed an increased pooled relative risk of 3.8 (95% CI ¼ 3.6, 4.1). However Rothwell et al (2012) in the study of individual patient data from 51 randomised trials of short- term effects of daily aspirin on cancer incidence, mortality and non-vascular death showed that the reduced risk of major vascular events was initially offset by an increased risk of major bleeding, but effects on both outcomes diminished with increasing follow- up, leaving only the reduced risk of cancer from 3 years onwards. Case-fatality from major extracranial bleeds was also lower on aspirin than on control (OR ¼ 0 32, 95% CI ¼ 0 12–0 83).

ABSTRACT No studies have examined the relationships between bacterial communities along sites of the upper aerodigestive tract of an individual subject. Our objective was to perform an intrasubject and intersite analysis to determine the contributions of two upper mucosal sites (mouth and nose) as source communities for the bacterial microbiome of lower sites (lungs and stom- ach). Oral wash, bronchoalveolar lavage (BAL) fluid, nasal swab, and gastric aspirate samples were collected from 28 healthy subjects. Extensive analysis of controls and serial intrasubject BAL fluid samples demonstrated that sampling of the lungs by bronchoscopy was not confounded by oral microbiome contamination. By quantitative PCR, the oral cavity and stomach con- tained the highest bacterial signal levels and the nasal cavity and lungs contained much lower levels. Pyrosequencing of 16S rRNA gene amplicon libraries generated from these samples showed that the oral and gastric compartments had the greatest species richness, which was significantly greater in both than the richness measured in the lungs and nasal cavity. The bacterial communities of the lungs were significantly different from those of the mouth, nose, and stomach, while the greatest similarity was between the oral and gastric communities. However, the bacterial communities of healthy lungs shared significant member- ship with the mouth, but not the nose, and marked subject-subject variation was noted. In summary, microbial immigration from the oral cavity appears to be the significant source of the lung microbiome during health, but unlike the stomach, the lungs exhibit evidence of selective elimination of Prevotella bacteria derived from the upper airways.

Methylation of the high-risk human papillomavirus type 16 (HPV16) upstream regulatory region (URR) has been described, but whether methylation is present among low-risk HPVs is unknown. The methylation status of the HPV6 URR was analyzed in papillomas from the upper aerodigestive tract of six adult patients. All CpGs in the URR were unmethylated, from both basal/ intermediate and superficial cells, suggesting that methylation is not involved in the regulation of transcription from the HPV6 URR, regardless of epithelial differentiation.

Results: We took lung fluid and upper aerodigestive tract (oropharyngeal) swab samples from 40 lambs (7 weeks old). DNA extraction was performed, and the V2-V3 region of the 16S rRNA gene was amplified by PCR then sequenced via Illumina Miseq. Oropharyngeal swabs were either dominated by bacteria commonly associated with the rumen or by bacteria commonly associated with the upper aerodigestive tract. Lung microbiota samples did not resemble either the upper aerodigestive tract samples or reagent-only controls. Some rumen-associated bacteria were found in lung fluids, indicating that inhalation of ruminal bacteria does occur. We also identified several bacteria which were significantly more abundant in lung fluids than in the upper aerodigestive tract swabs, the most predominant of which was classified as Staphylococcus equorum.