RESUMEN
Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.
RESUMEN
Cancer of unknown primary (CUP) site comprises very heterogeneous group of various malignant tumors presented in metastatic phase of the disease. Diagnosis is set when primary site remains unidentified after a thorough diagnostic evaluation in patients with histologically proven malignant metastatic disease. Despite poor prognosis in most patients, favorable prognostic clinical entities have been recognized constituting the most important group of patients for oncological treatment. The following text presents the clinical guidelines in order to standardize the diagnosis, treatment and follow-up of patients with cancer of unknown primary site in the Republic of Croatia.
Asunto(s)
Neoplasias Primarias Desconocidas/diagnóstico , Neoplasias Primarias Desconocidas/terapia , Croacia , Humanos , PronósticoRESUMEN
CONCLUSION: Multivariate analysis showed age, lymph node status, proliferative index in transformation border, and DNA index in the center of laryngeal squamous cell carcinoma to be significant predictors for survival. By accessing distinctive areas of the tumor we were able to reduce the impact of intratumoral heterogeneity on prognostic factors. OBJECTIVES: Laryngeal carcinomas are characterized by considerable histological variation within the tumor. The possible effects of this morphological heterogeneity on the estimation of tumor DNA content were investigated. MATERIALS AND METHODS: We analyzed 92 cases of archived, paraffin-embedded laryngeal carcinoma. For each tumor, three different regions, defined microscopically (center of tumor, transformation border, invasive border), were analyzed. DNA content was measured by flow cytometry. Three parameters were evaluated: DNA ploidy, DNA index, and proliferative index. RESULTS: DNA ploidy, DNA index, and proliferative index were higher in the tumor center than in the respective borders. Intratumoral differences in DNA ploidy were observed in 56 tumors (60.8%); DNA index heterogeneity was observed in 57.6% cases. Proliferative index varied greatly in morphologically different parts of the same carcinoma. DNA ploidy and DNA index of the transformation border correlated with tumor size and lymph node status. Proliferative index of the tumor center and of transformation border correlated with lymph node status, tumor size, and histological grade.
Asunto(s)
Aneuploidia , Carcinoma de Células Escamosas/genética , ADN de Neoplasias/genética , Neoplasias Laríngeas/genética , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , División Celular/genética , División Celular/fisiología , Diploidia , Femenino , Citometría de Flujo , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Laringe/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Pronóstico , Tasa de SupervivenciaRESUMEN
The harmonic scalpel cuts and coagulates simultaneously using a mechanical vibration. The present article reports our experience in the use of this instrument. Over a period of 5 months, we performed 123 thyroidectomies, 13 parotidectomies and 25 tonsillectomies using the harmonic scalpel. 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies were performed with the use of conventional hemostatic techniques (electrocautery and knot tying). The use of harmonic scalpel shortened the duration of thyroid and parotid surgery by 20-30% as compared with the conventional techniques. The average incision length for those undergoing thyroidectomy with the harmonic scalpel was 1.5 cm shorter compared with the conventional thyroidectomy group. The use of harmonic scalpel shortened the average duration of tonsillectomy by 5.5 minutes. Postoperative pain and complication rate were comparable for both groups. The use of the harmonic scalpel reduces surgical time and intraoperative blood loss, and enables shorter incision length in thyroid surgery.
Asunto(s)
Glándula Parótida/cirugía , Instrumentos Quirúrgicos , Tiroidectomía/instrumentación , Tonsilectomía/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemostasis Quirúrgica/instrumentación , Humanos , Masculino , Persona de Mediana Edad , UltrasonidoRESUMEN
Transition from malignant schwannoma to malignant triton tumor is analyzed in a case report on a patient with recurring cancers and suspected familial predisposition. It is hypothesized that rhabdomyoblastic differentiation, which distinguishes triton from schwannoma, might be attributable to Hedgehog-Patched pathway malfunctioning. Loss of one Patched gene allele was found in the tissue of advanced triton, but the retained allele had no exon or promoter mutations. Protein levels at early cancer stages indicated possible Patched response to the pathway activation in the first occurrence of triton tumor. Later, in the recurring triton, Patched expression was several times lower than in the control tissue, suggesting that haploinsufficiency was aided by silencing of the remaining allele, although its promoter was not hypermethylated. These findings may justify further investigation of the Hedgehog-Patched pathway role in triton malignancies, especially because of the recent research on the therapeutical potential of the pathway.
Asunto(s)
Proteínas Hedgehog/genética , Mutación/genética , Neoplasias de la Vaina del Nervio/genética , Neurilemoma/genética , Transducción de Señal , Anciano , Cromatografía Líquida de Alta Presión , Inhibidor p16 de la Quinasa Dependiente de Ciclina , Femenino , Proteínas Hedgehog/metabolismo , Humanos , Técnicas para Inmunoenzimas , Pérdida de Heterocigocidad , Masculino , Repeticiones de Microsatélite , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/metabolismo , Neoplasias de la Vaina del Nervio/metabolismo , Neoplasias de la Vaina del Nervio/patología , Neurilemoma/metabolismo , Neurilemoma/patología , Neurofibromina 1/genética , Neurofibromina 1/metabolismo , Receptores Patched , Linaje , Receptores de Superficie Celular/genética , Receptores de Superficie Celular/metabolismo , Receptores Acoplados a Proteínas G/genética , Receptores Acoplados a Proteínas G/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Receptor Smoothened , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Proteína con Dedos de Zinc GLI1RESUMEN
The aim of this study is to test the possible prognostic significance of p53 and Ki67 expression in inverted papilloma of the lateral nasal wall and adjacent sinuses regarding their malignant potential and recurrence. 49 biopsies of the lateral nasal wall and adjacent sinuses obtained from 41 patients from three hospitals were investigated. Immunohistochemically demonstrated p53 and Ki67 expression was measured and statistically evaluated. p53 immunoreactivity was demonstrated in most of papillomas with carcinomas but only in two benign papillomas, while Ki67 demonstrated stronger immunoreactivity in carcinomas and surrounding epithelium. Immunohistochemical staining of inverted sinonasal papillomas for p53 and Ki67 can give useful information concerning the existence of synchronous carcinoma and, in case of high Ki67, a hint toward possible recurrence.
Asunto(s)
Antígeno Ki-67/metabolismo , Papiloma Invertido/metabolismo , Neoplasias de los Senos Paranasales/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Papiloma Invertido/patología , Neoplasias de los Senos Paranasales/patología , PronósticoRESUMEN
Several oncogenes and tumor-suppressor genes are involved either as early or late event in thyroid gland carcinogenesis. Human FHIT (fragile histidine triad) gene is highly conserved gene whose loss of function may be important in the development and/or progression of various types of cancer. We undertook this study to analyze FHIT and p53 gene status in different benignant and malignant thyroid tumors. Status of these genes as well as intensity of apoptosis was analyzed in tumor tissues by molecular genetic methods, immunohistochemistry, and FACS-scan analysis. The majority of the malignant thyroid cancers displayed aberrant expression of FHIT gene, concominant with p53 gene inactivation. This is followed by low rate of apoptosis, which may be important in the development and/or progression of thyroid cancer. We found higher incidence of p53 mutation and aberrant processing of FHIT mRNA in malignant tumors (papillary, follicular, medullary and anaplastic carcinomas) and in those tumors with distant metastasis. The growth of p53(-)/FHIT(-) follicular carcinoma of human origin was much faster in nude mice than p53(+)/FHIT(+) follicular carcinoma, and mice had shorter survival rate. Our results show a correlation between aberrant FHIT and p53 expression, low rate of apoptosis, and malignancy. Concomitant aberration of FHIT gene and p53 could be responsible for development of highly malignant types of thyroid cancer and may be considered as a prognostic marker for these tumors.
Asunto(s)
Ácido Anhídrido Hidrolasas/genética , Genes p53 , Mutación , Proteínas de Neoplasias/genética , Enfermedades de la Tiroides/genética , Neoplasias de la Tiroides/genética , Ácido Anhídrido Hidrolasas/metabolismo , Adolescente , Adulto , Anciano , Animales , Apoptosis , Femenino , Citometría de Flujo , Expresión Génica , Humanos , Inmunohistoquímica , Pérdida de Heterocigocidad , Masculino , Ratones , Ratones Desnudos , Persona de Mediana Edad , Biología Molecular , Proteínas de Neoplasias/metabolismo , Trasplante de Neoplasias , Enfermedades de la Tiroides/metabolismo , Enfermedades de la Tiroides/patología , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/patología , Trasplante HeterólogoRESUMEN
Inverted papilloma is an epithelial neoplasm of the lateral nasal wall and adjacent sinuses characterized by a marked propensity for recurrence and a significant association with carcinoma. In this retrospective study we present 31 cases treated by our departments between 1982 and 1999. The aim was to compare our results to those of other authors especially regarding surgical management. The male to female ratio of these patients was 2:1 and most patients were in the 6th and 7th decades of life. Conservative surgery was used in most cases as the initial treatment. The overall recurrence rate was low and there were 3 cases associated with carcinoma. We conclude that the results of conservative surgery in selected cases are comparable to those using radical methods. A review of the literature is presented and particular attention is dedicated to the literature concerning analysis of p53 expression, HPV and Epstein-Barr infection and apoptosis in inverted papilloma.