A Case of Lymphoepithelial Carcinoma Originating in the Submandibular Gland

Lymphoepithelial carcinoma is an extremely rare malignant tumor, especially those localized at the head and neck region. The histological prototype of lymphoepithelial carcinoma is undifferentiated nasopharyngeal carcinoma. Herein, we report a case of a tumor localized in the left submandibular gland in a 20-year-old male. The tumor mass was surgically excised with the submandibular gland, and the specimen was pathologically confirmed to be lymphoepithelial carcinoma.

A common symptom with an uncommon diagnosis

Background Nasopharyngeal carcinoma is one of the uncommon tumours and the most difficult tumour to diagnose at an earlier stage due to the clandestine and deceptive nature. The incidence is more common in men with a peak incidence of 50 to 60 years. The suspicion of tumour at the earliest stage is very helpful in reducing morbidity and mortality. Case presentation A 45-year-old female presented with right hemi cranial headache for 2years without any comorbidities for that she consulted many hospitals and got symptomatic and empherical treatment in which her symptoms resolved temporarily and recurred. We did diagnostic nasal endoscopy and found a smooth globular mass in the right nasopharynx with contrast enhanced computerised tomography mass extending into the muscle plane which was found with the confirmation of diagnosis as undifferentiated nasopharyngeal carcinoma by histopathological examination and treated accordingly. Conclusion Although the diagnosis of the nasopharyngeal carcinoma in the earlier stage is difficult, it is an imperative one because the prognosis depends upon the stage of the disease in which it has been diagnosed. The clinicians always should have a suspicion of the rare disease for a day-to-day unresolved symptom, because the earlier diagnosis and appropriate management helps in the prevention of the life-threatening complications of any disease.

The Role of Cyclin D1 and VEGF in Radiotherapy Response of Advance Stage Undifferentiated Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma has a high incidence and mortality rate in Southeast Asia and Indonesia. Radioresistance is a major obstacle to successful treatment of nasopharyngeal carcinoma. DNA repair in the cell cycle and angiogenesis factors affects the response of tumor cells to radiotherapy. Cyclin D1 that functions in the cell cycle process and VEGF as an angiogenesis factor are considered to play a role in the occurrence of radioresistance. The objective of this study is to find the association between immunoexpression of Cyclin D1 and VEGF with radiotherapy response in undifferentiated nasopharyngeal carcinoma. This study used a retrospective case control analysis design, secondary data from medical records of patients diagnosed as undifferentiated nasopharyngeal carcinoma who received complete radiotherapy at the Radiation Oncology Department Dr Hasan Sadikin Bandung were taken. There were 44 samples divided into radiosensitive (22 samples) and radioresistant (22 samples) groups. Immunohistochemical examination of Cyclin D1 and VEGF was performed on paraffin blocks of patients' biopsy. Data analysis using Chi-Square test (p ≤0.05) , OR 95% CI. Cyclin D1 expressed strongly in 86.4% of the radioresistant group and 59.1% in the radiosensitive group (p<0.05) and the OR 4,385 (0.993-19.356), VEGF was strongly expressed in 77.3% of the radioresistant group and 54.5% in the radiosensitive group (p>0.05). As conclusion, there were significant association between Cyclin D1 with radiotherapy respons in undifferentiated nasopharyngeal carcinoma. The stronger immunoexpression of Cyclin D1, the higher likelihood of radioresistancy. VEGF immunoexpression showed no significant association with radiotherapy response.

The Role of Cyclin D1 and VEGF in Radiotherapy Response of Advance Stage Undifferentiated Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma has a high incidence and mortality rate in Southeast Asia and Indonesia. Radioresistance is a major obstacle to successful treatment of nasopharyngeal carcinoma. DNA repair in the cell cycle and angiogenesis factors affects the response of tumor cells to radiotherapy. Cyclin D1 that functions in the cell cycle process and VEGF as an angiogenesis factor are considered to play a role in the occurrence of radioresistance. The objective of this study is to find the association between immunoexpression of Cyclin D1 and VEGF with radiotherapy response in undifferentiated nasopharyngeal carcinoma. This study used a retrospective case control analysis design, secondary data from medical records of patients diagnosed as undifferentiated nasopharyngeal carcinoma who received complete radiotherapy at the Radiation Oncology Department, Dr. Hasan Sadikin Bandung were taken. There were 44 samples divided into radiosensitive (22 samples) and radioresistant (22 samples) groups. Immunohistochemical examination of Cyclin D1 and VEGF was performed on paraffin blocks of patients' biopsy. Data analysis using Chi-Square test (p≤0.05) , OR 95% CI. Cyclin D1 expressed strongly in 86.4% of the radioresistant group and 59.1% in the radiosensitive group (p<0.05) and the OR 4,385 (0.993-19.356), VEGF was strongly expressed in 77.3% of the radioresistant group and 54.5% in the radiosensitive group (p>0.05). As conclusion, there were significant association between Cyclin D1 with radiotherapy respons in undifferentiated nasopharyngeal carcinoma. The stronger immunoexpression of Cyclin D1, the higher likelihood of radioresistancy. VEGF immunoexpression showed no significant association with radiotherapy response.

THE EFFECT OF GINKGO BILOBA AGAINST OTOTOXIC HEARING LOSS ON ADVANCED STAGE UNDIFFERENTIATED NASOPHARYNGEAL CARCINOMA RECEIVING CISPLATIN CHEMOTHERAPY

Introduction: Undifferentiated nasopharyngeal carcinoma is the most common malignant tumor in nasopharynx, in which most patients come to a hospital in advanced stage. Cisplatin is one of the most effective widely used chemotherapy drugs for advanced stage undifferentiated nasopharyngeal carcinoma. Although it provides a successful outcome against cancer, there is serious side effect namely ototoxic hearing loss. Ginkgo biloba is a powerful antioxidant which may prevent ototoxic hearing loss. Objective: The study aims to determine the effect of ginkgo biloba against ototoxic hearing loss on advanced stage undifferentiated nasopharyngeal carcinoma receiving cisplatin chemotherapy. Methods: This study was double blind Randomized Control Trial with pre-post test design, was conducted in 22 patients with advanced stage undifferentiated nasopharyngeal carcinoma receiving cisplatin chemotherapy at the Department of Otorhinolaryngology Head and Neck Surgery dr. Moewardi Hospital Surakarta between June 1st and October 1st 2019. The subjects were allocated into control (plasebo) and treatment (80 mg Ginkgo biloba extract) groups. Hearing function was examined with pure tone audiometry, tympanometry and Distortion Product Otoacoustic Emission before and after the first, the second and the third cisplatin chemotherapy. The results of the examination of the two groups were tested using Friedman and Chi Square test. P value of <0.05 was considered significant. Results: The study subjects were mostly male (63.6%), with the age range of 40-59 years (90.9%). The baseline characteristics of the study subjects were homogeneous (p>0.05). There was a significant difference in the incidence of ototoxic hearing loss between control and treatment group after getting the second and the third chemotherapy (p=0.043 and p=0.033, respectively). Conclusion: There is a significant effect of ginkgo biloba in term of preventing ototoxic hearing loss on advanced stage undifferentiated nasopharyngeal carcinoma patients receiving cisplatin chemotherapy.

Cancer-Associated Fibroblasts in Undifferentiated Nasopharyngeal Carcinoma: A Putative Role for the EBV-Encoded Oncoprotein, LMP1

Undifferentiated nasopharyngeal carcinoma (NPC) is 100% associated with Epstein–Barr virus (EBV) infection, and biopsies display variable levels of expression of the viral oncoprotein, latent membrane protein 1 (LMP1). Emerging evidence suggests an important role for cancer-associated fibroblasts (CAFs) in the NPC tumour microenvironment, yet the interaction between the virus, its latent gene products and the recruitment and activation of CAFs in the NPC tumour stroma remains unclear. This short review will discuss the current evidence for the importance of CAFs in NPC pathogenesis and outline a putative role for the EBV-encoded oncoprotein, LMP1, in governing tumour–stromal interactions.

NASOPHARYNGEAL CARCINOMA CHARACTERISTIC AT ARIFIN ACHMAD HOSPITAL IN JANUARY-OCTOBER 2018

Introduction: Nasopharyngeal carcinoma is the most head and neck malignancy worldwide that is capable of performing distant metastasis and potentially to relapse. Indonesia prevalence of cancer estimate 1.4% or approximately 347.792 population and the highest found in D.I Yogyakarta, whereas Riau province counted 0.7% or around 4.301 population. This concludes the nasopharyngeal carcinoma stand as the 4th of the most malignancy in Indonesia after the mamae carcinoma, cervix carcinoma, and skin tumor. Objective: The purpose of this study is to asses the characteristic of NPC patient in Arifin Achmad Hospital Riau Province involving the incidence, gender, age, histopathology classification, distribution by the period and the therapy. Material and method: Retrospective cross-sectional approach with the descriptive presentation to assess the entire population of nasopharyngeal carcinoma based on gender, age, histopathology classification and treatment in January to October 2018. The data obtained from several data provide unit and process into a frequent and distribution table. Result: The number of the cases obtained include the new case and old case was 137 cases sequently 62 new cases and 75 old cases. Men were most affected and the commonest occurring in range 40-60 years. All the most histopathology classification was the undifferentiated nasopharyngeal carcinoma. Most of the patient treated with chemotherapy. Conclusion: NPC was the highest incidence of the head and neck malignancy commonly in men. All the most occurred in early elderly and the highest histopathology type was undifferentiated nasopharyngeal carcinoma (WHO Type III). Chemotherapy was the choice to treat the patient.

Update in pediatric nasopharyngeal undifferentiated carcinoma

Many of the principles established in adults with undifferentiated nasopharyngeal carcinoma (NPC) apply to children, adolescents and young adults. However, NPC in young patients should be distinguished from the adult form by several points. This review focuses mainly on differences between adult and pediatric NPC. The role of biology and genetics in pediatric NPC is discussed. Systemic treatment modalities including type of chemotherapy induction, timing of treatment, role of immunotherapy as adjuvant treatment, or in relapsing/ metastatic diseases are reported. Radiation modalities (doses, techniques…) in children are also reviewed. Long-term effects including secondary cancers are finally be discussed in this young NPC population.

THE RELATION OF EBNA-1 AND EGFR EXPRESSION SCREENING FROM ADVANCED STAGE UNDIFFERENTIATED NASOPHARYNGEAL CANCER

Introduction: Nasopharyngeal carcinoma (NPC) is a lymphoepithelial malignancy of the nasopharynx, one of the etiologies is the infection of Epstein–Barr virus in undifferentiated type of nasopharyngeal carcinoma. The Epstein-Barr virus Nucleus Antigen-1 (EBNA-1) is Epstein–Barr virus-encoded proteins as regulatory virus transcription. Epithelial Growth Factor Receptor (EGFR) consist of a single polypeptide chain of amino acid, ErbB members, tyrosine kinase receptor, a transmembrane glycoprotein encoded by gen location in the short arms of a chromosome and overexpression in epithelial tumors. EGFR plays a central role in signal transduction pathways which regulate key cellular functions in epithelial malignancies. and may also present in NPC. Objective: To investigate this relation of expression patterns of EBNA-1 and EGFR in a histological type of undifferentiated nasopharyngeal carcinoma. Method: Observational, analytical study with a cross-sectional method of 34 formalin-fixed within inclusion criteria are EBNA-1 and positive staining of EGFR expression (30 patients) and exclusion criteria of negative staining of EGFR (4 patients). All biopsy samples work with paraffin embedded and resulted in hematoxylin-eosin undifferentiated histological types of the advanced stage in nasopharyngeal carcinoma. EBNA-1 and EGFR expression used immunohistochemistry staining. Result: EBNA-1 and EGFR expression level were detection and correlated with the advanced stadium of nasopharyngeal undifferentiated carcinoma. Conclusion: EBNA-1 is significantly related to EGFR expression in the advanced stadium of undifferentiated nasopharyngeal carcinoma. Overexpression of EGFR is mostly found in advanced NPC but not in all ages. Male is dominated and overall age below 55 years old. Screening of EGFR with immunohistochemistry is highly considered before anti-EGFR treatment