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Mezenhimske matične stanice (MMS) su multipotentne progenitorske stanice podrijetlom od odraslih tkiva, koje imaju sposobnost diferencijacije u različita tkiva mezodermalnog podrijetla, uključujući kost, hrskavicu i masno tkivo. Danas se za istraživačke i terapijske svrhe MMS najčešće izoliraju iz koštane srži (KS-MMS), no problemi vezani uz njihovu primjenu uključuju morbiditet donorskog mjesta, malen broj izoliranih stanica za terapijske svrhe i slabljenje diferencijacijskog potencijala s povećanjem dobi davatelja. Sve navedeno razlog je potrazi za alternativnim i mlađim donorskim izvorima MMS. U ovoj se disertaciji prvi put predstavlja i opisuje izolacija MMS iz nepčanih tonzila. Izvršena je komparativna i kvantitativna analiza adherentnih stanica iz tog tkiva, nazvana tonzilarnim MMS (T-MMS). T-MMS su uspoređene s KS-MMS, dobro istraženim i karakteriziranim tipom MMS. Analiza površinskih biljega pokazala je da T-MMS nemaju CD14, CD31, CD34 i CD45, a da izražavaju CD29, CD44, CD90 i CD105 biljege, što je karakterističan fenotip KS-MMS. Poput KS-MMS, i T-MMS je bilo moguće diferencirati u adipocite, osteocite i hondrocite. Diferencijacijski potencijal T-MMS je analiziran histološkim i histokemijskim pretragama, te RT-PCR analizom ekspresije gena znakovitih za pojedina mezenhimska tkiva. Populacija stanica izoliranih iz tonzila na površini ne izražava MHC molekule II. razreda, što može omogućiti terapijsku primjenu alogenih T-MMS. S obzirom na jednostavan kirurški pristup i izostanak etičkih dvojba oko tonzilektomije, ljudske nepčane tonzile mogle bi se iskoristiti kao prikladan alternativni izvor mladih i brzo proliferirajućih progenitorskih stanica za bazična istraživanja i terapijske primjene., Mesenchymal stem cells (MSCs) are adult multipotent progenitor cells that have the ability to differentiate into lineages of mesenchymal tissues including cartilage, bone and fat. They were originally isolated from bone marrow (BM-MSCs), but current challenges of clinical application of BM-MSCs include donor-site morbidity, and low cell yields associated with age-related decrease in cell number and differentiation potential, underscoring the need to identify alternative sources of MSCs. In the present work, the presence of MSCs in tonsillar tissue is reported for the first time. We performed comparative and quantitative analyses of BM-MSCs with a subpopulation of adherent cells isolated from this lymphoid tissue, termed tonsil-derived MSCs (T-MSCs). Surface epitope analysis revealed that T-MSCs were negative for CD14, CD31, CD34 and CD45 expression and positive for CD29, CD44, CD90 and CD105 expression, a characteristic phenotype of BM-MSCs. Similar to BM-MSCs, T-MSCs could be induced to undergo adipogenic, osteogenic and chondrogenic differentiation. Differentiation potential of T-MSCs was analyzed histologically, histochemically and by RT-PCR for the expression of lineage related marker genes. T-MSCs did not express class II MHC antigens, suggesting a potential role as a human allogeneic cell source for cell-based therapies. Thus, human palatine tonsil-derived MSCs, which are easily accessible without ethical concerns, represent an attractive alternative source for adult progenitor cells or MSCs for basic research and future clinical applications.

Endoscopic CO2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly reported advantages of ELS are good oncologic results with low incidence of complications. Although less common if compared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood transfusion, or revision surgery. We present our institutional experience, discuss the possible complications of ELS for laryngeal cancer, and outline the concepts of their treatment, with comprehensive literature review. Complications are more frequent following the treatment of supraglottic as compared to glottic cancer. If compared with open surgery, ELS for laryngeal cancer is associated with a lower incidence of complications. Every surgeon performing ELS should comply with particular strategies to avoid complications in the first place, and have a clear concept of their management if they occur.

In head and neck squamous cell carcinoma distant metastases are rare and metastases to the heart are extremely rare. In this report we present a patient with a sublingual and laryngeal carcinoma with metastases to lung and heart. Cardiac metastases present with non-specific symptoms that depends on the size and location of the metastases. The ideal tools for diagnosing cardiac metastases are echocardiography and cardiac MRI. CT scan could be used as a screening method of distant metastases in head and neck cancer. The treatment of cardiac metastases is generally ineffective.

We present our experience with primary CO2 laser surgery for planocellular supraglottic carcinoma. During a ten-year period, we performed 64 curative supraglottic laryngectomies. Twenty-nine patients presented with T1 and 35 with T2 carcinoma. There were 46 patients without regional and/or distant metastases (N0 neck), and 18 patients with N+ neck. Thirty-three (52%) patients were treated with surgery alone, and in 31 (48%) patients surgical procedure was combined with radiotherapy. Estimated overall 5-year survival for all patients was 89%. Local and regional tumor control as well as survival rate were comparable with the results of other therapeutic options, i.e. radiotherapy or open supraglottic laryngectomy. Functional results outline the advantages of endoscopic laser surgery for laryngeal carcinoma. Transoral endoscopic CO2 laser surgery is efficacious treatment for T1 and T2 supraglottic carcinoma, and can be combined with neck dissection and postoperative irradiation.