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MAGE-A as a novel approach in the diagnostic accuracy of oral squamous cell cancer: a case report.

Metzler P, Mollaoglu N, Schwarz S, Neukam FW, Nkenke E, Ries J - Head Neck Oncol (2009)

Bottom Line: Histopathological examination revealed no malignancy.Results indicated significant MAGE-A3 and A4 expression pattern.Therefore, the lesion was excised completely and an early invasive carcinoma was identified.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Craniomaxillofacial and Oral Surgery, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland. Philipp.Metzler@usz.ch

ABSTRACT

Background: The aim of this case report is to introduce the combined use of brush biopsy and measurement of MAGE-A expression in the diagnosis of oral squamous cell carcinoma (OSCC).

Case report: We report of a 49-year old male patient who was referred to our department with a persistent-suspicious looking leukoplakia. Brush biopsy and an incisional biopsy were performed following clinical diagnosis. Histopathological examination revealed no malignancy. Expression analysis of melanoma-associated antigens A (MAGE-A) using real time RT-PCR was applied to brush biopsy materials because of the high prevalence of MAGE-A determined previously in OSCC's. Results indicated significant MAGE-A3 and A4 expression pattern. Therefore, the lesion was excised completely and an early invasive carcinoma was identified.

Conclusion: These results emphasize the role of brush biopsy using a tumor marker with a high expression frequency combined with a high sensitive and high specific detection system in the early diagnosis of OSCC, particularly in widespread leukoplakias.

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Related in: MedlinePlus

Expression analysis of MAGE-A3 and -A4 by real time RT-PCR, NOM* (Normal oral mucosa); Rn represents the raw flurescence signal over time.
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Figure 5: Expression analysis of MAGE-A3 and -A4 by real time RT-PCR, NOM* (Normal oral mucosa); Rn represents the raw flurescence signal over time.

Mentions: A 49-year old patient was referred to the Department of Oral and Maxillofacial Surgery at the University of Erlangen-Nuremberg following OSCC of the left floor of the mouth, including the partial resection of the mandible, neck dissection and local reconstruction. The histopathological examination displayed pT1 pN0 cM0 G2 R0 status. Adjuvant radiotherapy was not carried out because of the low invasion depth of 3 mm. Patient was closely monitored during regular follow-up intervals. Five months later, leukoplakia at the patient's left palatoglossal arch was diagnosed (Figure 1). No induration was palpable. Subsequently, the lesion was biopsied by scalpel at the most suspicious site. The histological examination of the incisional biopsy showed a hyper- and parakeratosis (thickening and keratinization characterized by the retention of nuclei of the stratum corneum), but no malignancy (Figure 2). Additionally, this lesion was routinely smeared using a commercially available cytobrush (Cytobrush® Plus GT, Medscand Medical AB, Sweden). Sampling was made with a moderate pressure and permanent rotation within the whole lesion in order to harvest cells. The brush was then rolled out on a slide by taking care of cell folding, air-dried and stained according to Papanicolaou. The following histopathological analysis of the specimen showed an epithelial dysplasia (atypical epithelial cells with polygonal epithelial cells showing clear cytoplasm and isomorphic, oval, small nuclei) (Figure 3). For further accuracy of methodical diagnosis of exfoliative cytology, we established a highly sensitive multimarker real time RT-PCR assay to detect the OSCC-related MAGE-A genes using a brush biopsy. As a negative control, healthy contralateral oral mucosa was smeared. The following molecular analysis revealed a significant increase of MAGE-A3 and A4 expression in the leukoplakia in contrast with the healthy oral mucosa where no MAGE-A expression profile was determined (Figure 4 and 5). A surgical resection and further histopathological examination was finally performed which revealed an early invasive carcinoma of the oral mucosa (Figure 6).


MAGE-A as a novel approach in the diagnostic accuracy of oral squamous cell cancer: a case report.

Metzler P, Mollaoglu N, Schwarz S, Neukam FW, Nkenke E, Ries J - Head Neck Oncol (2009)

Expression analysis of MAGE-A3 and -A4 by real time RT-PCR, NOM* (Normal oral mucosa); Rn represents the raw flurescence signal over time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803165&req=5

Figure 5: Expression analysis of MAGE-A3 and -A4 by real time RT-PCR, NOM* (Normal oral mucosa); Rn represents the raw flurescence signal over time.
Mentions: A 49-year old patient was referred to the Department of Oral and Maxillofacial Surgery at the University of Erlangen-Nuremberg following OSCC of the left floor of the mouth, including the partial resection of the mandible, neck dissection and local reconstruction. The histopathological examination displayed pT1 pN0 cM0 G2 R0 status. Adjuvant radiotherapy was not carried out because of the low invasion depth of 3 mm. Patient was closely monitored during regular follow-up intervals. Five months later, leukoplakia at the patient's left palatoglossal arch was diagnosed (Figure 1). No induration was palpable. Subsequently, the lesion was biopsied by scalpel at the most suspicious site. The histological examination of the incisional biopsy showed a hyper- and parakeratosis (thickening and keratinization characterized by the retention of nuclei of the stratum corneum), but no malignancy (Figure 2). Additionally, this lesion was routinely smeared using a commercially available cytobrush (Cytobrush® Plus GT, Medscand Medical AB, Sweden). Sampling was made with a moderate pressure and permanent rotation within the whole lesion in order to harvest cells. The brush was then rolled out on a slide by taking care of cell folding, air-dried and stained according to Papanicolaou. The following histopathological analysis of the specimen showed an epithelial dysplasia (atypical epithelial cells with polygonal epithelial cells showing clear cytoplasm and isomorphic, oval, small nuclei) (Figure 3). For further accuracy of methodical diagnosis of exfoliative cytology, we established a highly sensitive multimarker real time RT-PCR assay to detect the OSCC-related MAGE-A genes using a brush biopsy. As a negative control, healthy contralateral oral mucosa was smeared. The following molecular analysis revealed a significant increase of MAGE-A3 and A4 expression in the leukoplakia in contrast with the healthy oral mucosa where no MAGE-A expression profile was determined (Figure 4 and 5). A surgical resection and further histopathological examination was finally performed which revealed an early invasive carcinoma of the oral mucosa (Figure 6).

Bottom Line: Histopathological examination revealed no malignancy.Results indicated significant MAGE-A3 and A4 expression pattern.Therefore, the lesion was excised completely and an early invasive carcinoma was identified.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Craniomaxillofacial and Oral Surgery, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland. Philipp.Metzler@usz.ch

ABSTRACT

Background: The aim of this case report is to introduce the combined use of brush biopsy and measurement of MAGE-A expression in the diagnosis of oral squamous cell carcinoma (OSCC).

Case report: We report of a 49-year old male patient who was referred to our department with a persistent-suspicious looking leukoplakia. Brush biopsy and an incisional biopsy were performed following clinical diagnosis. Histopathological examination revealed no malignancy. Expression analysis of melanoma-associated antigens A (MAGE-A) using real time RT-PCR was applied to brush biopsy materials because of the high prevalence of MAGE-A determined previously in OSCC's. Results indicated significant MAGE-A3 and A4 expression pattern. Therefore, the lesion was excised completely and an early invasive carcinoma was identified.

Conclusion: These results emphasize the role of brush biopsy using a tumor marker with a high expression frequency combined with a high sensitive and high specific detection system in the early diagnosis of OSCC, particularly in widespread leukoplakias.

Show MeSH
Related in: MedlinePlus