diagnosis and surgical manage ment of cutaneous malignancies were of adequate standard .

doi:10.1016/j.oraloncolo gy.2013.03.228

OP220

Adenoid cystic carcinom a of oral cavity – A case series with various clinical manifes tations Ranjitkum ar Patil a, Bowate Rahul b, Akhilana nd Chaurasia a,Anurag Tripathi a

a Dept. of Oral Medicine & Radiology, King George Medical University,Lucknow , India b Dept. of Oral Medicin e & Radiolo gy, Sharad Pawar Dental College,Datta Meghe Institute of Medical Sciences, Wardha, India

Adenoid cystic carcinoma is an uncommo n form of malignant neoplasm that arises within secretory gland, most common ly the major and minor salivary glands of head and neck, comprise s 4% ofall salivary gland tumors. Other sites of origin include trachea, lacri- mal gland, breast, skin and uvula.

In older literature it is sometim es referred to as cylindroma . Most individual s are diagnosed with the disease in fourth through sixth decades of life with a median age of 43 years. There is a slight female preponder ance (female to male ratio approximatel y 3:2). They com- monly present as a slowly growing tumor with severe pain and occa- sionally with facial nerve paraly sis as tumor infiltrates into this nerve. An intra-oral adenoid cystic carcinoma may exhibit mucosal ulceration which distingu ish it from benign mixed tumor. Radiolog -ically, the tumor reveals extension into adjacent bone.

Another unusual feature of ACC is that it seldom metastas izes toregional lymph nodes. Distant metastasis is most common presenta- tion of treatment failure. Poor prognostic signs at the time of initial surgery are a solid growth pattern, perineural invasion of major nerves and/or positive margins after histopathol ogic examina tion.Here we are presentin g five cases with various clinical manifestati ons.

doi:10.1016/j.oraloncolo gy.2013.03.229

OP221

In vitro and in vivo inhibition effects of artesuna te on a novel human palatal salivary gland adenoid cystic carcinom a cell line Xiaolin Nong, Yixing Li, Jiaquan Li, Hang Xu

Purpose : To investigat e the effects of artesunat e on adenoid cystic carcinoma cell line named NACC.

Materia l and Method s: Cell growth inhibition was detected bymethyl thiazol yl tetrazoli um and clone formation assaies after NACC cell line were treated with various concentrat ions of artesunat ein vitroly, morphologi cal changes were observed by inverted micros- copy and electron microscop y. Wound healing and flow cytometry assay was used to analyze NACC cell migration , cell cycles and cell apoptosis after artesunat e treated. NACC cells were inoculated sub- cutaneous into BABL-C nude mice for xenografts and treatment started on the 7th day when solid tumors were palpated, groupin gas: control, artesunates, cialpatin and artesun ate plus cialpatin trea- ted groups. Drugs were given everyoth er days for eight times. On the 23th day, the animals were sacrificed then tumors were excised and weighted. Tumors were also investigat ed by immun ohistochem istry and western bloting.

Results: The 25–200 lg/ml artesunat e produced prolifera tion inhi- bition and apopto sis induction on NACC cell line in a time-and does- depende nt manner. IC50 of artesun ate in 24, 48 and 72 h were 113.09, 74.80, 35.61 lg/ml respect ively. Cell cycle of NACC cell could be arrested the in G1 phase by 12.5–50.0 lg/ml and G2 phase by50.0–200.0 lg/ml of artesun ate. Artesunate could change the mor- phologic al structure and significantly inhibited the migration and clone formation of NACC cell. Artesunat e 200 mg/kg groups effi-ciently inhibited the growth of NACC xenograft; artesunat e 50 mg/ kg combined with cisplatin 1.0 mg/kg also resulted in significantgrowth inhibit of the tumors. VEGF, Bcl-2, ERK2 were down-re gu- lated in ART 100 mg/kg, ART 200 mg/kg and ART plus DDP groups.In artesun ate 200 mg/kg and ART plus DDP groups had differen tdegrees of down-re gulation of CXCR4, CD44, CD133 express.

Conclusions: ART might significantly inhibit the growth of NACC cell in vitro and in vivo, by adjustin g the cell cycle, inducing apopto- sis and inhibiting neovascul arization.

doi:10.1016/j.oraloncology.20 13.03.230

OP222

Stem-li ke populations of salivary adenoid cystic carcinom a and tumor -sphere formation Diana Bell a, Randal Weber b, Ehab Hanna b

a Departme nt of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, USA b Departme nt of Head and Neck Surgery , The University of Texas M.D.Anderson Cancer Center, Houston, USA

Background : The morpho logic heterogen eity of human salivary gland tumors belies the traditional concept of tumor progression through stepwise alteration s in multiple molecular and cellular pathway s. The cancer stem-like cell (CSC) hypothesi s states that asubpopul ation of intratu moral cells is uniquely capable of propagat- ing the tumor, relying on hierarchic al model to explain tumor heter- ogeneity and behavior. CSCs are a subset of self-sustaini ng cancer cells with exclusive ability to maintain the tumor. Self-renew al, mul- tipotency, and increased proliferati ve capacity allow CSC popula- tions to maintain a pluripotent phenotyp e, while also producing aheterogen eous tumor. CSCs have been reported in solid tumors :breast, brain, prostate, lung, colon, pancreas, liver, and skin. The CSC concept – if applicable to adenoid cystic carcinoma (AdCC) –allows for a better understan ding of aggressive tumor cell biologic traits, such as chemor esistance and metastasis.

We hypothesize that salivary AdCC contains CSC-like cells. The present project was designed to test the ability of salivary adenoid cystic cancer stem-like cells derived from primary tumors to form tumor spheres.

Material and Methods: ACC cell lines: SACC-83 cells.Clinical samples: 2 solid tumor samples were collected from

patients with AdCC of salivary glands.Sphere formation: we adapted the protocol publish ed for mam-

mosphe res formation.Results: Identification and enrich ment of stem-like cells. Cell clus-

ters could be identified within 24 h, and after 48 h, spheres P 60 lmwere evident as determ ined with an eyepiece reticle and stage micrometer .

Tumor spheroids. To characteriz e the tumorsphere cells, cytospin cell preparati ons were immun ostained for markers of differen tiated luminal epithelial cells (cytokeratin cocktail, CK7), differen tiated myoepi thelial cells (cytokeratin, CK 14, p63), and progenito r cells (p63, NOXA).

Abstracts / Oral Oncology 49 (2013) S80–S92 S87

Tumorsphe res from both passages were positive for cytokerati ncocktail and cytokerat in 7 was present in smaller procentage of cells.

Both keratins were decorating the cells in a cytoplasm ic and membran ous pattern of staining. p63, a myoepithe lial nuclear mar- ker was detected in spheroids from both passag es although the num- ber of p63 positive cells in the second spheroid passag e was lower compared to the first passag e. ALDH activity. As an alternati ve, the Aldefluor assay is used to identify and isolate stem-like cells from primary adenoid cystic carcinoma samples. In our attempts with the Aldefluor assay, the second passage showed a small procenta geof ALDH + CD133 + stem cells present in the SACC-83 cell line and tumorsphere s derived from solid tumor.

Conclusion: Cancer stem cells (CSCs) are believed to be responsi ble for ACC formation and recurren ce. These cells can be identified inestablishe d cell lines and primary patient samples. CSCs can be iden- tified on the basis on function al activity (self-renewal, serial tumor propagation) and phenotypic markers.

doi:10.1016/j.oraloncolo gy.2013.03.231

OP223

Osteotomy in the vertical ramus of the mandibula r foraman for tumors in the infratem poral fossa Wei-liang Chen a, Wei-jian Wang b

a Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen Univers ity, Guangzho u, China b Departme nt of Oral and Maxillofaci al Surgery, General Hospital ofGuangzhou Military Command of PLA, Guangzhou , China

Background: Although several techniques have been described for to access to infratemporal fossa, surgical managemen ts of the para- pharyngeal space tumors remains a challenge.

Objectives: This study investig ated a simple and safe technique being used to access to infratemporal fossa tumors.

Material and methods: Between January 2010 to January 2012,eight patien ts with primary infratemp oral fossa tumors (two sch- wannomas, two pleomorphic adenoma, one Warthin’s tumor, one lipoma, one chordo ma and one adenoid cystic carcinoma ) were treated with an approach of osteotom y in the vertical ramus out- side the mandibula r foraman at the Departmen t of Oral and Max- illofacial Surgery, the Sun Yat-sen Memori al Hospital, Sun Yat-sen Universit y, Guangz hou, China. This study was approved by the institution al review board. Of the eight patients, six were male and two were female. The mean age was 42.4 months (range19–62 years). The diagnoses were based on the clinical history,physical examinati on and instrumental (computed tomograp hyor magneti c resonance imaging) assessment (Fig. 1) and confirmedby permanent patholog ic sections. Primary sites of the lesions were the infratempo ral fossa pleomorph ic adenoma (2), schwan- nomas (two cases), Warthin’s tumor (1), lipoma (1), chordo maadenoid cystic carcinoma (1) and adenoid cystic carcinoma (1).The sizes of the tumors varied from a minimum of 4 cm � 4 cmto a maximum of 6 � 7 cm, median 5.0 � 5.5 cm. Infratempor alfossa malignant tumors patients who underwent surgical resection received adjuvant 48.6 Gy in total of dose fractionated stereotactic radiotherap y.

Results: All of the tumors were removed completel y and withou trupture. No patient exhibited any permanent postoperat ive compli- cation. Neither patient had malocclusion or other dental complica- tions from the approach. One patient had slight transient postope rative facial paresis, which resolved spontaneous ly within

4 weeks . The patients were followed for 7–26 months (average,17 months). No recurre nce was encount ered.

Conclusion: This simple, safe technique can be used to access to infra-temporal fossa tumors while preserving the inferior alveolar nerve.

doi:10.1016/j.oraloncology.2013.03.232

OP224

Bisphosp honate-rel ated osteonecros is of the jaws. Treatment protoco l includ ing hyperba ric oxygen therapy and surgical interv ention Georgios Karakinaris, Katherine Triantafillidou,Konstant inos Antoniad es

Departme nt of Oral and Maxillofaci al Surgery , Aristotle University ofThessalo niki, Greece

Purpose: Bisphosph onate-relat ed osteonecrosi s of the jaws (BROJ)is a serious complicatio n of bisphosphon ate taking, mainly when administere d intravenousl y. Addressing this problem was and is still a clinical dilemma. The manage ment protocols that have been pro- posed have many differen ces between them. The definitive treat- ment is difficult and long, while it is impossibl e to achieve without surgic al intervent ion and without stopping the responsib le drug.

Materials and method s: During the period 2005–2012 45 patien tswith osteonecros is of the jaws faced in our departmen t. Of these,one group of 25 patients regardless of the damage extension were able to follow the proposed protocol and the others were treated with more conserva tive methods. The treatment protocol started with interrupti on of bisphosphon ates for a period longer than 6 month s. Subsequent ly the patients underwent 30 sessions ofhyperbari c therapy preoperati vely and 10 postoperat ively. The surgi- cal procedure was as minimal as possible, limited in removal ofnecrotic bone.

Results: Patients who underwent surgical interventio n in this pro- tocol had on the whole successful final outcome. Itraoperativ ely was found sequestrat ion and eliminatio n of necrotic area of the jaws. Inthree of these patients a second surgical interventio n had to bemade. However, all patients ultimately are free of osteon ecrosis.One patient who had to restart bisphosphon ate administr ation isfor a year without recurre nce of the lesion. In some cases the fol- low-up period free of recurrence is so much that the patients had safely underwent prosthetic rehabilitati on with dental implants.

Conclusions : Although the selection of patients undergoin g this protocol is nonrandom ized and based inter alia on criteria such asoverall good health of patients, life expectancy and accessibi lity tohyperbari c oxygen chamber, is accompa nied by very good results.

doi:10.1016/j.oraloncology.2013.03.233

OP225

The predic tive value of dendritic cells in early carcinoma of the tongue Ohad Hilly a, Yulia Strenov b, Roy Hod a, Yotam Shkedy a,Gideon Bachar a, Thomas Shpitzer a

a Departme nt of Otolaryngolo gy, Head and Neck Surgery , Rabin Medical Center, Petach Tikva, Israel b Department of Pathology, Rabin Medical Center, Petach Tikva, Israel

S88 Abstracts / Oral Oncology 49 (2013) S80–S92