Invasive squamous cell carcinoma (SCC) of the cervix involves the progression of premalignant cervical intraepithelial neoplasia (CIN) and is associated with persistent human papillomavirus infection. Most CINs will regress, and the challenge is to identify the lesions likely to progress to invasive cancer. We evaluated Sirtuin 1 (SIRT1) expression in nonneoplastic cervix, CINs, and SCCs as a potential biomarker to predict disease progression. A total of 101 cases were selected including 29 CIN 1s, 32 CIN 2s, 16 CIN 3s, 2 microinvasive SCCs, and 22 invasive SCCs. Cervical nonneoplastic squamous epithelium showed weak positivity of SIRT1 in the basal layer. SIRT1 cytoplasmic overexpression was found in 13.8% of CIN 1s (4/29), 40.6% of CIN 2s (13/32), and 50% of CIN 3s (8/16), and it was statistically significant between CIN 1 and CIN 2/3 lesions (P=.01). All 24 cases of invasive and microinvasive SCC showed SIRT1 overexpression, with 25% (6/24) showing cytoplasmic staining only, 4.2% (1/24) showing nuclear staining only, and 70.8% (17/24) showing both nuclear and cytoplasmic staining. From CIN 1 to SCC, SIRT1 expression showed steady and statistically significant increase (CIN 1 versus CIN 2-3, P=.01; CIN 2-3 versus SCC, P=.0001). Thus, SIRT1 may serve as a potential biomarker for predicting the progression of CIN to invasive SCC.

Dirofilariasis is caused by filarial nematodes (roundworms) of the genus Dirofilaria Dirofilariasis of the oral mucosa is very rare. Herein, we report a case of a 79-year-old man who had a slowly growing infiltrative mass in the right buccal space. Histopathologic examination showed an inflammatory infiltrate with eosinophilia, histiocytes, and small organisms (0.2-0.3 mm). Digital images were sent to the Centers for Disease Control and Prevention, which identified the parasite as a nematode in the genus Dirofilaria It appeared to be dead and degenerating, but external, fine longitudinal cuticular ridges and the presence of tall muscle cells were diagnostic. Thus, Dirofilaria, despite its rarity, should be considered in the differential diagnosis of tumor-like lesions in the buccal mucosa.

The incidence rates of invasive cervical cancer have markedly decreased in the past decades. Nonetheless, approximately 12,900 new cases and 4,100 estimated deaths are expected in 2015. The development of invasive squamous cell carcinoma (SCC) of the cervix involves the progression of premalignant stages and is associated with persistent infection of HPV types. Therefore, biomarkers that can predict progression of cervical intraepithelial neoplasms (CIN) are of great clinical significance. One marker that is actively being researched in a variety of malignancies is Sirtuin1 (SIRT1), a nicotinamide adenine dinucleotide (NAD+)-dependent histone deacetylase. Overexpression of SIRT1 has been reported to induce tumorigenesis. Our previous unpublished data showed that SIRT1 was overexpressed in many CIN2/3 (40.6% and 50%) and only few CIN1 (13.8%; P = .01). In this study, we evaluated the expression of SIRT1 in cervical SCC to analyze its potential as a biomarker and its role in tumorigenesis. 24 cases of invasive SCC were selected and H&E slides were reviewed. The diagnosis of invasive SCC was confirmed, including 2 cases of microinvasive carcinoma. SIRT1 immunohistochemistry was performed and results were compared with our previous CIN study. Fisher exact test was used for statistical analysis. All 24 SCCs (100%) showed strong and diffuse cytoplasmic SIRT 1 staining (2+-3+), and most cases also showed nuclear SIRT1 expression. From CIN1, CIN2, and CIN3 to invasive SCC, SIRT1 overexpression showed steady increase from 13.8%, 40.6%, 50%, and 100% (CIN1 vs CIN2-3, P = .01; CIN2-3 vs SCC, P = 0). Nuclear SIRT1 positivity was only observed in SCC. SIRT1 overexpression was observed in all invasive SCC cases, and nuclear expression of SIRT1 was noted in most invasive SCCs but not in CIN1-3. Therefore, SIRT1 appears to have a significant role in cervical SCC tumorigenesis and is a promising biomarker for predicting progression of CIN.

Carcinosarcoma of the parotid is a rare biphasic malignant neoplasm comprised of both carcinomatous and sarcomatous components representing approximately 0.4% of all malignant salivary gland neoplasms. We report a case of a 55-year-old Caucasian man who presented with a progressively enlarging left facial mass. Histopathological evaluation of the tumoral tissue revealed a high grade, mixed epithelial and mesenchymal malignant tumor, most consistent with a carcinosarcoma of the parotid. Morphoproteomic analysis was performed and revealed expression of secreted protein acidic and rich in cysteine (SPARC); glioma-associated oncogen protein 2 (Gli2); and phosphorylated signal transducer and activator of transcription (p-STAT3 [Tyr705]) in the carcinomatous and malignant mesenchymal components. These aforementioned markers have been linked to the epithelial-mesenchymal transition in which epithelial cells lose their characteristics and phenotypically become mesenchymal cells. This finding allows us to further understand the biology of the 2 cellular components of the carcinosarcoma as having a monoclonal origin.

Metastases to the submandibular gland are extremely rare; a literature search retuned only three previously reported cases from a thyroid gland primary site.Herein, we report two cases of metastatic thyroid carcinoma to the submandibular gland in a 64-year-old woman with PTC and a 70-year-old-woman with medullary thyroid carcinoma (MTC). The metastases were identified on CT and PET/CT in one case and on CT in the other case, but both were diagnosed with ultrasound-guided fine-needle aspiration. Our cases highlight that while rare, both PTC and MTC can metastasize to the submandibular gland. K E Y W O R D S medullary thyroid carcinoma, papillary thyroid carcinoma, submandibular gland, metastases, ultrasound