fibrin and Laryngeal-Neoplasms

There has been an ongoing confusion among pathologists in their attempt to accurately identify lesions of Reinke's space. Nodules, polyps and Reinke's edema fall in the same basket and differentiation between them relies largely on the clinical description of the pathologic specimen by the operating surgeon than on their distinct pathologic features. By revising the pertinent literature, the need for an establishment of the aforementioned term still remains and is further stressed out, as confusion among the various pathologic descriptions of these lesions still exists. This is further verified by a study conducted in the Department of Otorhinolaryngology-Head and Neck Surgery of the University Hospital of Louvain at Mont-Godinne, Belgium, involving 323 operative specimens obtained from 200 patients with macroscopic picture. Statistical analysis showed lack of agreement between surgical and histopathologic diagnosis in almost a third of the cases (Cohen's kappa coefficient of 0.683 +/- 0.037, P < 0.001). We, therefore, propose the term "exudative lesions of Reinke's space" to include Reinke's edema, polyps and nodules. These lesions share common histologic features, which are located in the Reinke's space and whose macroscopic appearance is largely dependent upon the presence and duration of certain causative factors.

Topics: Exudates and Transudates; Female; Fibrin; Humans; Laryngeal Diseases; Laryngeal Edema; Laryngeal Neoplasms; Laryngoscopy; Laser Therapy; Male; Polyps; Retrospective Studies; Terminology as Topic; Vocal Cords

Immunohistochemistry was applied to AMeX-fixed tissue sections of 12 adenocarcinomas of the stomach (seven intestinal adenocarcinomas and five diffuse carcinomas), 12 adenocarcinomas of the pancreas (nine ductal adenocarcinomas and three signet ring carcinomas), and 12 squamous cell carcinomas of the larynx obtained at surgical resection to examine the possibility of extravascular activation of blood coagulation in cancer tissues by exploring the in loco patterns of distribution of fibrinogen, a final product of blood coagulation, fibrin, and a by-product of coagulation reactions (prothrombin fragment 1+2). Gastric, pancreatic, and laryngeal cancers exhibited fibrinogen antigen in abundance throughout the tumor stroma. Fibrin was detected along the edges of nests of carcinoma cells and at the host-tumor interface. Prothrombin fragment 1+2 was present in the blood vessels in areas of neoangiogenesis at the host-tumor interface (gastric and pancreatic cancer tissues) and on the tumor cell bodies (pancreatic and laryngeal cancer tissues). The presence of prothrombin fragment 1+2 in cancer tissues appears to be a good indicator of coagulation activation and thrombin generation at the tumor burden.

Topics: Adenocarcinoma; Biomarkers; Blood Coagulation; Carcinoma, Squamous Cell; Fibrin; Gastrointestinal Neoplasms; Immunohistochemistry; Laryngeal Neoplasms; Neovascularization, Pathologic; Pancreatic Neoplasms; Peptide Fragments; Prothrombin; Stomach Neoplasms; Stromal Cells

Extravascular fibrin deposition is frequently observed within and around neoplastic tissue and has been implicated in various aspects of tumor growth. The distribution of fibrin deposits was investigated in squamous cell carcinomas representing different stages of tumor progression of the larynx (n = 25) and hypopharynx (n = 9) by immunofluorescent techniques. Double and treble labelings were used to detect fibrinogen and fibrin in combination with marker antigens for tumor cells (cytokeratin), endothelial cells (von Willebrand factor), macrophages (recognized by KiM7), as well as factor XIII subunit A (FXIIIA) and tenascin (an embryonic extracellular matrix protein newly expressed during tumorigenesis). All tissue samples showed specific staining for fibrinogen/fibrin. Fibrin deposition was localized almost exclusively in the connective tissue compartment of tumors with characteristic accumulation at the interface of connective tissue and the tumorous parenchyma. In certain tumor samples showing highly invasive characteristics, fibrin deposits were observed in close association with tumor blood vessels in the tumor cell nodules. The overlapping reactions with polyclonal antibody to fibrinogen/fibrin and monoclonal antibody to fibrin indicate the activation of the coagulation cascade resulting in in situ thrombin activation and fibrin formation. Fibrin was crosslinked and stabilized by FXIIIA as revealed by urea insolubility test. Accumulation of phagocytozing macrophages detected by Ki M7 monoclonal antibody could be seen in areas of fibrin deposition. The blood coagulation factor XIIIA was detected in and around the cells labeled with Ki M7 antibody. Tenascin and fibrin deposits were found in the same localization in the tumor stroma and in association with tumor blood vessels within the tumor cell nodules. Neither fibrin nor tenascin were detected in the histologically normal tissue adjacent to tumors. The close association between fibrin deposits and macrophage accumulation strongly suggests the active participation of tumor-associated macrophages in the formation of stabilized intratumoral fibrin that facilitates tumor matrix generation and tumor angiogenesis.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Disease Progression; Female; Fibrin; Fibrinogen; Fluorescent Antibody Technique, Indirect; Humans; Hypopharyngeal Neoplasms; Keratins; Laryngeal Neoplasms; Macrophages; Male; Middle Aged; Neoplasm Proteins; Tenascin; Thrombophilia; Transglutaminases

A 40-year-old woman was hoarse for five months due to a pleomorphic adenoma in the false vocal cord. The peripheral, ulcerated portion of the tumor had undergone squamous metaplasia, and this was initially misdiagnosed as squamous cell carcinoma. For that reason, the patient received radiation treatment, but the tumor remained unchanged. It was then locally excised, and the patient was still free of disease 14 years later. This case illustrates the hazard of misinterpreting squamous metaplasia in pleomorphic adenoma, the resistance of this tumor to irradiation, and the satisfactory long-range response to local excision.

Topics: Adolescent; Adult; Aged; Biopsy; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Fibrin; Humans; Laryngeal Neoplasms; Male; Middle Aged; Neoplasms, Germ Cell and Embryonal

Topics: Adult; Basement Membrane; Capillary Permeability; Endothelium; Female; Fibrin; Humans; Laryngeal Neoplasms; Male; Microscopy, Electron; Vocal Cords