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Abstract Objective: To evaluate alterations in the masticator space due to the dissemination of malignant neoplasms originating from the tonsillar fossa, retromolar trigone, maxillary sinus, or nasopharynx, using computed tomography (CT), as well as to correlate the presence of trismus with the CT findings and the dimensions of the tumor. Materials and Methods: We evaluated the medical records of 65 patients with malignant tumors in the regions described. The images were analyzed by two physician examiners, working independently, who were blinded to the clinical data. In the evaluation of the masticator space, the following parameters were considered: symmetry with the contralateral space; obliteration of the fat plane, retromolar trigone, or pharyngeal space; edema/atrophy of the medial or lateral pterygoid muscles; and destruction of the mandibular ramus. Results: Obliteration of the fat plane was found in 69.2% of the patients. Asymmetry, edema/atrophy, and bone destruction were detected in 27.7%, 26.2%, and 20.0% of the patients, respectively. Trismus was identified in 15.4% of the patients. Of the patients with trismus, 90.0% had stage T4 tumors, compared with only 43.8% of those without trismus. Trismus was 11.6 times more common among the patients with stage T4 tumors than among those with lower-stage tumors. Neoplasms of the tonsillar fossa and retromolar trigone collectively accounted for 95.0% of the cases. The CT scans showed edema/atrophy of the pterygoid muscles in 60.0% of the patients with trismus and in 21.8% of those without. An association was observed between T4 tumor stage and edema/atrophy of the pterygoid muscles. In addition, the risk of trismus was 5.4 times higher among the patients with stage T4 tumors. Conclusion: In our patient sample, the most common finding was obliteration of the fat plane, followed by asymmetry and edema/atrophy. Most of the patients with T4 tumors had trismus, together with edema/atrophy of the pterygoid muscles.
Resumo Objetivo: Avaliar, por meio de tomografia computadorizada, alterações do espaço mastigador (EM) decorrentes de disseminação de neoplasias malignas originárias da loja tonsilar, trígono retromolar, seio maxilar e nasofaringe, e correlacionar presença de trismo com achados tomográficos e dimensões do tumor. Materiais e Métodos: Foram selecionados prontuários de 65 pacientes portadores de tumores malignos nas regiões descritas. A análise das imagens foi realizada por dois examinadores médicos, separadamente, sem o conhecimento das informações clínicas. Na avaliação do EM, foram considerados: simetria com o EM contralateral; obliteração do plano gorduroso, do trígono retromolar e do espaço faríngeo; edema e/ou atrofia dos músculos pterigóideos medial e lateral; destruição do ramo da mandíbula. Resultados: Foram observados obliteração do plano gorduroso em 69,2% dos pacientes, assimetria em 27,7%, espessamento/atrofia em 26,2% e destruição óssea em 20,0%. Presença de trismo foi encontrada em 15,4% dos pacientes. Na associação entre dimensão do tumor e trismo, foram observados trismo em 90,0% dos tumores em estágio T4, enquanto a porcentagem de tumores em estágio T4 sem trismo foi de 43,8%. Pacientes com tumores T4 apresentaram 11,6 vezes mais trismo que os dos demais estágios. Neoplasias da loja tonsilar e trígono retromolar perfizeram 95,0% dos casos. Em 60,0% dos pacientes com trismo havia edema e/ou atrofia dos músculos pterigóideos na tomografia computadorizada e em 21,8% nos sem trismo. Observou-se associação entre tumores T4 e edema e/ou atrofia dos músculos pterigóideos e 5,4 vezes mais chance de apresentarem trismo. Conclusão: A maioria dos pacientes apresentou obliteração do plano gorduroso, seguido de assimetria e espessamento/atrofia. O trismo estava presente na maioria dos pacientes T4 com espessamento/atrofia dos músculos pterigóideos.
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Objective: To evaluate alterations in the masticator space due to the dissemination of malignant neoplasms originating from the tonsillar fossa, retromolar trigone, maxillary sinus, or nasopharynx, using computed tomography (CT), as well as to correlate the presence of trismus with the CT findings and the dimensions of the tumor. Materials and Methods: We evaluated the medical records of 65 patients with malignant tumors in the regions described. The images were analyzed by two physician examiners, working independently, who were blinded to the clinical data. In the evaluation of the masticator space, the following parameters were considered: symmetry with the contralateral space; obliteration of the fat plane, retromolar trigone, or pharyngeal space; edema/atrophy of the medial or lateral pterygoid muscles; and destruction of the mandibular ramus. Results: Obliteration of the fat plane was found in 69.2% of the patients. Asymmetry, edema/atrophy, and bone destruction were detected in 27.7%, 26.2%, and 20.0% of the patients, respectively. Trismus was identified in 15.4% of the patients. Of the patients with trismus, 90.0% had stage T4 tumors, compared with only 43.8% of those without trismus. Trismus was 11.6 times more common among the patients with stage T4 tumors than among those with lower-stage tumors. Neoplasms of the tonsillar fossa and retromolar trigone collectively accounted for 95.0% of the cases. The CT scans showed edema/atrophy of the pterygoid muscles in 60.0% of the patients with trismus and in 21.8% of those without. An association was observed between T4 tumor stage and edema/atrophy of the pterygoid muscles. In addition, the risk of trismus was 5.4 times higher among the patients with stage T4 tumors. Conclusion: In our patient sample, the most common finding was obliteration of the fat plane, followed by asymmetry and edema/atrophy. Most of the patients with T4 tumors had trismus, together with edema/atrophy of the pterygoid muscles.
Objetivo: Avaliar, por meio de tomografia computadorizada, alterações do espaço mastigador (EM) decorrentes de disseminação de neoplasias malignas originárias da loja tonsilar, trígono retromolar, seio maxilar e nasofaringe, e correlacionar presença de trismo com achados tomográficos e dimensões do tumor. Materiais e Métodos: Foram selecionados prontuários de 65 pacientes portadores de tumores malignos nas regiões descritas. A análise das imagens foi realizada por dois examinadores médicos, separadamente, sem o conhecimento das informações clínicas. Na avaliação do EM, foram considerados: simetria com o EM contralateral; obliteração do plano gorduroso, do trígono retromolar e do espaço faríngeo; edema e/ou atrofia dos músculos pterigóideos medial e lateral; destruição do ramo da mandíbula. Resultados: Foram observados obliteração do plano gorduroso em 69,2% dos pacientes, assimetria em 27,7%, espessamento/atrofia em 26,2% e destruição óssea em 20,0%. Presença de trismo foi encontrada em 15,4% dos pacientes. Na associação entre dimensão do tumor e trismo, foram observados trismo em 90,0% dos tumores em estágio T4, enquanto a porcentagem de tumores em estágio T4 sem trismo foi de 43,8%. Pacientes com tumores T4 apresentaram 11,6 vezes mais trismo que os dos demais estágios. Neoplasias da loja tonsilar e trígono retromolar perfizeram 95,0% dos casos. Em 60,0% dos pacientes com trismo havia edema e/ou atrofia dos músculos pterigóideos na tomografia computadorizada e em 21,8% nos sem trismo. Observou-se associação entre tumores T4 e edema e/ou atrofia dos músculos pterigóideos e 5,4 vezes mais chance de apresentarem trismo. Conclusão: A maioria dos pacientes apresentou obliteração do plano gorduroso, seguido de assimetria e espessamento/atrofia. O trismo estava presente na maioria dos pacientes T4 com espessamento/atrofia dos músculos pterigóideos.
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Extracellular vesicles (EVs) are mediators of the immune system response. Encapsulated in EVs, microRNAs can be transferred between cancer and immune cells. To define the potential effects of EVs originated from squamous cell carcinoma cells on immune system response, we performed microRNA profiling of EVs released from two distinct cell lines and treated dendritic cells derived from circulating monocytes (mono-DCs) with these EVs. We confirmed the internalization of EVs by mono-DCs and the down-regulation of microRNA mRNA targets in treated mono-DCs. Differences in surface markers of dendritic cells cultivated in the presence of EVs indicated that their content disrupts the maturation process. Additionally, microRNAs known to interfere with dendritic cell function, and detected in EVs, matched microRNAs from squamous cell carcinoma patients' plasma: miR-17-5p in oropharyngeal squamous cell carcinoma, miR-21 in oral squamous cell carcinoma, miR-16, miR-24, and miR-181a circulating in both oral and oropharyngeal squamous cell carcinoma, and miR-23b, which has not been previously described in plasma of head and neck squamous cell carcinoma, was found in plasma from patients with these cancer subtypes. This study contributes with insights on EVs in signaling between cancer and immune cells in squamous cell carcinoma of the head and neck.
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Células Dendríticas/metabolismo , Vesículas Extracelulares/genética , Neoplasias de Cabeza y Cuello/genética , MicroARNs/genética , Línea Celular Tumoral , Regulación Neoplásica de la Expresión Génica , Neoplasias de Cabeza y Cuello/sangre , Humanos , MicroARNs/sangre , TranscriptomaRESUMEN
PURPOSE: To compare global health-related quality of life (HRQoL) and overall survival (OS) in patients with head and neck cancer treated with intensity modulated radiation therapy (IMRT), conformal radiation therapy (3DCRT) or conventional radiation therapy (2DRT). METHODS AND MATERIALS: In this real-world, multi-institutional and prospective study, HRQoL outcomes were assessed using the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC QLQ-C30) and European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Head and Neck 43 (H&N43) questionnaires. Item response theory was used to generate a global HRQoL score, based on the 71 questions from both forms. The effect of treatment modality on HRQoL was studied using multivariate regression analyses. Survival was estimated using the Kaplan-Meyer method, and groups were compared by the log-rank test. RESULTS: Five hundred and seventy patients from 13 institutions were included. Median follow-up was 12.2 months. Concerning the radiation technique, 29.5% of the patients were treated with 2DRT, 43.7% received 3DCRT, and 26.8% were treated with IMRT. A higher proportion of patients receiving 2DRT had a treatment interruption of more than 5 days (69% vs 50.2% for 3DCRT and 42.5% for IMRT). IMRT had a statistically significant positive effect on HRQoL compared with 3DCRT (ß= 2.627, standard error = 0.804, P = .001) and 2DRT had a statistically significant negative effect compared with 3DCRT (ß= -5.075, standard error = 0.926, P < .001). Patients receiving 2DRT presented a worse OS (P = .01). There were no differences in OS when IMRT was compared with 3DCRT. CONCLUSIONS: IMRT provided better HRQoL than 3DCRT, which provided better HRQoL than 2DRT. Patients receiving 2DRT presented a worse OS, which might be related to more frequent treatment interruptions.
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Neoplasias de Cabeza y Cuello/radioterapia , Calidad de Vida , Radioterapia de Intensidad Modulada , Anciano , Brasil , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The recent reclassification of a follicular variant of papillary thyroid carcinoma (FVPTC), subset as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), aims to avoid overtreatment of patients with an indolent lesion. The diagnosis of NIFTP has recently been revisited using more rigid criteria. This study presents histological and molecular findings and a long clinical follow-up of 94 FVPTC, 40 cases of follicular adenoma (FTA) and 22 cases of follicular carcinoma (FTC) that were classified before the advent of the NIFTP reclassification. All slides were reviewed using these rigid criteria and analysis of numerous sections of paraffin blocks and reclassified as 7 NIFTPs, 2 EFVPTCs, 29 infiltrative FVPTC (IFVPTCs), 57 invasive EFVPTC (I-EFVPTCs), 39 FTAs and 22 FTCs. Remarkably, EFVPTC and NIFTP patients were all free of disease at the end of follow-up and showed no BRAF mutation. Only one NIFTP sample harbored mutations, an NRAS Q61R. PAX8/PPARG fusion was found in I-EFVPTCs and FTC. Although additional studies are needed to identify a specific molecular profile to aid in the diagnosis of lesions with borderline morphological characteristics, we confirmed that the BRAF V600E mutation is an important tool to exclude the diagnosis of NIFTP. We also show that rigorous histopathological criteria should be strongly followed to avoid missing lesions in which more aggressive behavior is present, mainly via the analysis of capsule or vascular invasion and the presence of papillary structures.
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BACKGROUND: Cigarette consumption has been identified as the main non-etiological factor in head and neck cancer (HNC) development. One of the main compounds in cigarettes is nicotine, which binds directly to nicotine acetylcholine receptors (nAchRs) in the body, which are encoded by different genes of the CHRNA family. Polymorphisms in some of these genes have been studied in relation to the risk of HNC and cigarette consumption intensity. The aim of this study was to evaluate whether there were associations between the CHRNA3 (rs578776) and CHRNA5 (rs16969968) polymorphisms and HNC risk and between the polymorphisms and the intensity of cigarette consumption. METHODS: A total of 1,067 individuals from Heliopolis Hospital in São Paulo were investigated, including 619 patients with HNC and 448 patients without diagnosed tumors. All participants answered a questionnaire about sociodemographic information and cigarette consumption data. The polymorphisms were determined by TaqMan genotyping by real-time PCR. RESULTS: The polymorphisms studied, rs578776 (CHRNA3) and rs16969968 (CHRNA5), did not have an association with HNC risk, but the rs16969968 homozygous genotype was associated with increased cigarette consumption intensity (OR 1.93, 95% CI 1.05-3.58). CONCLUSION: The polymorphism CHRNA5 can be considered an indirect risk factor for neoplasms in these Brazilian samples when cigarette consumption increased.
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Neoplasias de Cabeza y Cuello/genética , Proteínas del Tejido Nervioso/genética , Polimorfismo de Nucleótido Simple , Receptores Nicotínicos/genética , Fumar/epidemiología , Brasil/epidemiología , Estudios de Casos y Controles , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Neoplasias de Cabeza y Cuello/inducido químicamente , Heterocigoto , Humanos , Masculino , Fumar/efectos adversos , Encuestas y CuestionariosRESUMEN
Purpose: GSTM1 and GSTT1 present a polymorphism that can drive complete gene deletions. The current methodology can powerfully determine GSTM1 and GSTT1 copy number variations (CNVs), which may clarify the real contribution of each gene copies to the cellular detoxification process and tumour risk. However, only analysing the presence/absence of these genes yielded controversial results for several disorders, including cancer. Because head and neck cancer (HNC) is becoming a serious global health problem, this study determined the CNVs of GSTM1 and GSTT1 in an HNC case-control population and investigated the possible association between gene copy numbers and tumour risk. Methods: CNV was evaluated by (Ct) 2-ΔΔCt qPCR methodology in 619 HNC patients and 448 patients with no tumour diagnosis. Results: The genes copy number range was 0-3. The CNV of GSTM1 and GSTT1 frequencies were similar between the cases and control. Thus, none copy of GSTM1 and GSTT1 were associated with HNC risk. Notwithstanding, one copy of both genes had higher frequencies among individuals who carried GSTM1 and GSTT1. Conclusions: One copy number of GSTM1 and GSTT1 presented a higher frequency among carrier genes, but the CNV of GSTM1 and GSTT1 was not associated with HNC risk.
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Biomarcadores de Tumor/genética , Glutatión Transferasa/genética , Neoplasias de Cabeza y Cuello/genética , Adulto , Variaciones en el Número de Copia de ADN/genética , Femenino , Dosificación de Gen , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/genética , Factores de Riesgo , FumarRESUMEN
INTRODUCTION: The main risk factors for head and neck squamous cell carcinoma (HNSCC) are tobacco and alcohol consumption and human papillomavirus (HPV) infection. However, in a subset of patients, no risk factors can be identified. Glutathione S-transferase π (GTSP1) is a carcinogen-detoxifying enzyme that is activated by exposure to carcinogens, and it is associated with a reduction in response to toxic therapies. We studied the expression of GTSP1 in tumor and non-tumor tissue samples from patients with and without these risks to identify whether GTSP1 expression differs according to exposure to carcinogens. MATERIALS AND METHODS: Non-smoker/non-drinker (NSND) and smoker/drinker (SD) patients were matched according to age, gender, tumor site, TNM stage, grade and histological variants to establish 47 pairs of patients who have been previously tested for HPV. GTSP1 immunostaining was analyzed using a semi-quantitative method with scores ranging from 0 to 3 according to the area of immunostaining. RESULTS: GTSP1 expression was detected in the tumors of both groups. GTSP1 expression was higher in the non-tumor margins of SD patients (p = 0.004). There was no association between GTSP1 expression and positivity for HPV. No differences in survival were observed according to GTSP1 staining in tumors and non-tumor margins. CONCLUSION: This study showed that GTSP1 was expressed in tumors of HNSCC patients regardless of smoking, drinking or HPV infection status. The difference in GTSP1 expression in non-tumor margins between the two groups may have been due to two possible reasons. First, elevated GTSP1 expression in SD patients might be the result of activation of GTSP1 in response to exposure to carcinogens. Second, alternatively, impairment in the detoxifying system of GTSP1, as observed by the reduced expression of GTSP1, might make patients susceptible to carcinogens other than tobacco and alcohol, which may be the underlying mechanism of carcinogenesis in the absence of risk factors.
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Consumo de Bebidas Alcohólicas/epidemiología , Carcinoma de Células Escamosas/genética , Glutatión Transferasa/genética , Neoplasias de Cabeza y Cuello/genética , Infecciones por Papillomavirus/epidemiología , Fumar/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/epidemiología , Estudios de Casos y Controles , Femenino , Glutatión Transferasa/metabolismo , Neoplasias de Cabeza y Cuello/epidemiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. METHOD: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. RESULTS: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. CONCLUSIONS: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor. OBJETIVO: verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. MÉTODO: estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio piriforme em três, na laringe em dois, no seio maxilar em um e em um caso a lesão primária era oculta. Houve 29 esvaziamentos, sendo oito bilaterais e 10 unilaterais (26 radicais e três seletivos). O estadiamento revelou nove pacientes com tumor T4, um T3, seis T2, um T1 e um Tx. Cinco pacientes eram N0, nove N2b, um N2c e três N3. A média de linfonodos dissecados foi de 34,25. O esvaziamento cervical foi realizado por meio de uma única incisão localizada no terço médio do pescoço, coincidente com dobra cutânea, com extensão de cerca de 2 a 3 cm para trás da borda anterior do músculo trapézio e 3 a 4 cm da linha média para os esvaziamentos cervicais unilaterais. RESULTADOS: como complicações houve necrose de retalho miocutâneo em um paciente com radioterapia prévia, uma fistula linfática, uma deiscência do traqueostoma, um abscesso cervical, uma fístula salivar e uma deiscência de sutura. CONCLUSÕES: a incisão única e estendida proporciona exposição adequada das estruturas do pescoço, sem comprometer o tempo cirúrgico, mesmo em esvaziamentos bilaterais. Não compromete a ressecção de todos os linfonodos cervicais, apresenta excelentes resultados estéticos e funcionais e é facilmente associada com outras abordagens para ressecção do tumor primário.
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Disección del Cuello/métodos , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/cirugía , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Metástasis Linfática , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Estadificación de Neoplasias , Neoplasias Faríngeas/patología , Neoplasias Faríngeas/cirugía , Estudios ProspectivosRESUMEN
ABSTRACT Objective: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. Method: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. Results: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. Conclusions: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor.
RESUMO Objetivo: verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. Método: estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio piriforme em três, na laringe em dois, no seio maxilar em um e em um caso a lesão primária era oculta. Houve 29 esvaziamentos, sendo oito bilaterais e 10 unilaterais (26 radicais e três seletivos). O estadiamento revelou nove pacientes com tumor T4, um T3, seis T2, um T1 e um Tx. Cinco pacientes eram N0, nove N2b, um N2c e três N3. A média de linfonodos dissecados foi de 34,25. O esvaziamento cervical foi realizado por meio de uma única incisão localizada no terço médio do pescoço, coincidente com dobra cutânea, com extensão de cerca de 2 a 3 cm para trás da borda anterior do músculo trapézio e 3 a 4 cm da linha média para os esvaziamentos cervicais unilaterais. Resultados: como complicações houve necrose de retalho miocutâneo em um paciente com radioterapia prévia, uma fistula linfática, uma deiscência do traqueostoma, um abscesso cervical, uma fístula salivar e uma deiscência de sutura. Conclusões: a incisão única e estendida proporciona exposição adequada das estruturas do pescoço, sem comprometer o tempo cirúrgico, mesmo em esvaziamentos bilaterais. Não compromete a ressecção de todos os linfonodos cervicais, apresenta excelentes resultados estéticos e funcionais e é facilmente associada com outras abordagens para ressecção do tumor primário.
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Humanos , Disección del Cuello/métodos , Neoplasias de la Boca/cirugía , Neoplasias de la Boca/patología , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/secundario , Neoplasias Faríngeas/cirugía , Neoplasias Faríngeas/patología , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Estudios Prospectivos , Metástasis Linfática , Estadificación de NeoplasiasRESUMEN
ABSTRACT INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5 cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5 cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.
Resumo INTRODUÇÃO: Tumores dos nervos periféricos tipicamente derivam das células de Schwann da bainha dos nervos periféricos. Por serem incomuns, devem ser lembrados no diagnóstico diferencial pré-operatório. OBJETIVO: Relatar a experiência de serviço de referencia terciária. MÉTODO: De 1977 a 2013, 42 pacientes com tumores neurogênicos periféricos da cabeça e pescoço foram operados e analisados retrospectivamente. A confirmação diagnóstica pré-operatória deu-se por biópsia ou método de imagem. RESULTADOS: A média da idade foi de 41,7 anos, sendo 15 indivíduos (36%) do gênero masculino. O tamanho médio foi de 5,5 cm e 26 (61%) localizavam-se na face lateral do pescoço. A maior parte (39,9%) apresentou-se como tumor palpável assintomático. A maioria (39,9%) foi ressecadapor acesso cervical. A maioria originou-se de nervos cranianos. CONCLUSÕES: Tumores neurogênicos extracranianos apresentam-se com tamanho médio de 5,5 cm, na face lateral do pescoço, costumam originar-se de nervos cranianos e ser ressecados por via cervical.
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Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Neoplasias de los Nervios Craneales/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Biopsia , Neurilemoma/diagnóstico , Neurofibroma/diagnóstico , Neurofibromatosis/diagnóstico , Neurofibrosarcoma/diagnóstico , Estudios Retrospectivos , Atención Terciaria de Salud , Tomografía Computarizada por Rayos XRESUMEN
Objective: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. Methods: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic / tumoral Results: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. Conclusion: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.
Objetivo: avaliar a prevalência de alterações encontradas na tomografia computadorizada (TC) de tórax em pacientes com carcinoma epidermóide de cabeça e pescoço. Métodos: Foram analisadas retrospectivamente 209 TC de tórax de pacientes com carcinoma epidermoide de cabeça e pescoço. As alterações tomográficas foram estratificadas como: inflamatórias/infecciosas, parenquimatosas, nodulares incaracterísticas e nodulares metastáticas/tumorais Resultados: foram diagnosticadas alterações em 66,6 % dos exames. Destes, 25,3% representaram enfisema pulmonar; 18,8% micronódulos incaracterísticos; 12,9% metástases; 11,9% de linfonodomegalias torácicas; e, em 6,6%, foram detectadas tuberculose pulmonar ativa ou sequela, pneumonia ou sinais inflamatórios/infecciosos e espessamento ou derrame pleural. Conclusão: a prevalência de exames com alteração e o considerável índice de metástases detectadas, indicam que a TC de tórax deve ser solicitada para complementação diagnóstica e/ou estadiamento nos casos de câncer de cabeça e pescoço.
Asunto(s)
Humanos , Carcinoma de Células Escamosas/metabolismo , Neoplasias de Cabeza y Cuello/patología , Metástasis de la Neoplasia/diagnóstico por imagen , Radiografía Torácica , Tomografía Computarizada por Rayos X , PrevalenciaRESUMEN
INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.
Asunto(s)
Neoplasias de los Nervios Craneales/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Adolescente , Adulto , Anciano , Biopsia , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico , Neurofibroma/diagnóstico , Neurofibromatosis/diagnóstico , Neurofibrosarcoma/diagnóstico , Estudios Retrospectivos , Atención Terciaria de Salud , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
INTRODUCTION: A less extensive thyroidectomy could be used for patients in the low risk group.OBJECTIVE: To perform a critical follow-up after lobectomy with isthmusectomy for the treatment of papillary thyroid carcinoma in patients with a single nodule limited to the periphery of the lobe.METHODS: Thirty-one patients with thyroid papillary carcinoma operated on till 1993 were selected. They had undergone lobectomy with isthmusectomy. This is a retrospective cohort study in which the oncological outcome (contralateral and regional recurrence) and the reoperation complications (recurrent nerve paralysis/paresis and hypoparathyroidism) were evaluated. Descriptive analysis was employed.RESULTS: In the last decade (2003-2013), 6 (20%) contralateral recurrences were observed in the remaining lobe and in 1 of these cases (3%), contralateral lymph node metastases were noted. A completion thyroidectomy plus lymphadenectomy was performed, without modification of global survival.CONCLUSION: Because of the rate of 20% of contralateral recurrence after a 20-year follow-up, we suggest modification of the surgical paradigm for total thyroidectomy as an initial therapy.
INTRODUÇÃO: Uma cirurgia menos extensa da glândula tireoide poderia ser utilizada em pacientes do grupo de baixo risco.OBJETIVO: Realizar seguimento crítico após hemitireoidectomia para tratamento do carcinoma papilífero de tireoide em casos de nódulo único limitado à periferia do lobo.MÉTODO: Foram selecionados 31 pacientes portadores de carcinoma papilífero de tireoide operados, até 1993, por lobectomia mais istmectomia. Trata-se de um estudo retrospectivo de coorte sendo avaliados o resultado oncológico (recidiva contralateral e regional) e complicações de reoperação (paralisia/paresia de nervo recorrente e hipoparatireoidismo). Utilizou-se análise descritiva.RESULTADOS: Na última década, foram observados 6 (20%) casos de recidivas contralaterais (lobo remanescente) sendo que, em um caso, estava acompanhado de metástases linfonodais contralaterais (3%), sem impacto na sobrevida dos pacientes reoperados.CONCLUSÃO: A ocorrência de 20% de recidiva contralateral após uma média evolutiva de 20 anos sugere revisão do paradigma conservador para a totalização imediata da tireoidectomia.
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma/mortalidad , Carcinoma/cirugía , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugía , Estudios de Cohortes , Recurrencia Local de Neoplasia , Reoperación , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Tiroidectomía/métodosRESUMEN
INTRODUCTION: A less extensive thyroidectomy could be used for patients in the low risk group. OBJECTIVE: To perform a critical follow-up after lobectomy with isthmusectomy for the treatment of papillary thyroid carcinoma in patients with a single nodule limited to the periphery of the lobe. METHODS: Thirty-one patients with thyroid papillary carcinoma operated on till 1993 were selected. They had undergone lobectomy with isthmusectomy. This is a retrospective cohort study in which the oncological outcome (contralateral and regional recurrence) and the reoperation complications (recurrent nerve paralysis/paresis and hypoparathyroidism) were evaluated. Descriptive analysis was employed. RESULTS: In the last decade (2003-2013), 6 (20%) contralateral recurrences were observed in the remaining lobe and in 1 of these cases (3%), contralateral lymph node metastases were noted. A completion thyroidectomy plus lymphadenectomy was performed, without modification of global survival. CONCLUSION: Because of the rate of 20% of contralateral recurrence after a 20-year follow-up, we suggest modification of the surgical paradigm for total thyroidectomy as an initial therapy.
Asunto(s)
Carcinoma/mortalidad , Carcinoma/cirugía , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugía , Adolescente , Adulto , Anciano , Carcinoma Papilar , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Reoperación , Estudios Retrospectivos , Tasa de Supervivencia , Cáncer Papilar Tiroideo , Tiroidectomía/métodos , Factores de TiempoRESUMEN
BACKGROUND: Small non-coding regulatory RNAs control cellular functions at the transcriptional and post-transcriptional levels. Oral squamous cell carcinoma is among the leading cancers in the world and the presence of cervical lymph node metastases is currently its strongest prognostic factor. In this work we aimed at finding small RNAs expressed in oral squamous cell carcinoma that could be associated with the presence of lymph node metastasis. METHODS: Small RNA libraries from metastatic and non-metastatic oral squamous cell carcinomas were sequenced for the identification and quantification of known small RNAs. Selected markers were validated in plasma samples. Additionally, we used in silico analysis to investigate possible new molecules, not previously described, involved in the metastatic process. RESULTS: Global expression patterns were not associated with cervical metastases. MiR-21, miR-203 and miR-205 were highly expressed throughout samples, in agreement with their role in epithelial cell biology, but disagreeing with studies correlating these molecules with cancer invasion. Eighteen microRNAs, but no other small RNA class, varied consistently between metastatic and non-metastatic samples. Nine of these microRNAs had been previously detected in human plasma, eight of which presented consistent results between tissue and plasma samples. MiR-31 and miR-130b, known to inhibit several steps in the metastatic process, were over-expressed in non-metastatic samples and the expression of miR-130b was confirmed in plasma of patients showing no metastasis. MiR-181 and miR-296 were detected in metastatic tumors and the expression of miR-296 was confirmed in plasma of patients presenting metastasis. A novel microRNA-like molecule was also associated with non-metastatic samples, potentially targeting cell-signaling mechanisms. CONCLUSIONS: We corroborate literature data on the role of small RNAs in cancer metastasis and suggest the detection of microRNAs as a tool that may assist in the evaluation of oral squamous cell carcinoma metastatic potential.
Asunto(s)
Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Perfilación de la Expresión Génica , MicroARNs/genética , Neoplasias de la Boca/genética , Neoplasias de la Boca/patología , Anciano , Anciano de 80 o más Años , Secuencia de Bases , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/genética , Carcinoma de Células Escamosas/sangre , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Metástasis Linfática , Masculino , MicroARNs/sangre , Persona de Mediana Edad , Datos de Secuencia Molecular , Neoplasias de la Boca/sangre , Estadificación de Neoplasias , Análisis de Secuencia de ARNRESUMEN
OBJECTIVE: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. METHODS: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic/tumoral. RESULTS: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. CONCLUSION: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.
Asunto(s)
Carcinoma de Células Escamosas/metabolismo , Neoplasias de Cabeza y Cuello/patología , Metástasis de la Neoplasia/diagnóstico por imagen , Humanos , Prevalencia , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
Objective To evaluate the effect of time between surgery and postoperative radiation therapy on local recurrence of squamous cell carcinoma of the tongue and floor of the mouth. Methods A total of 154 patients treated between 1996 and 2007 were selected considering local recurrence rate and time of the adjuvant radiotherapy. Results Local recurrence was diagnosed in 54 (35%) patients. Radiation therapy reduced the rate of local recurrences, although with no statistical significance. The time between surgery and initiation of postoperative radiotherapy did not significantly influence the risk of local recurrence in patients referred to adjuvant treatment (p=0.49). Conclusion In the presence of risk factors for local recurrence, a short delay in starting the adjuvant radiation therapy does not contraindicate its performance. .
Objetivo Avaliar o efeito do tempo entre o tratamento cirúrgico e a radioterapia pós-operatória nas recidivas locais do carcinoma epidermoide de língua e soalho da boca. Métodos Foram selecionados 154 pacientes tratados entre 1996 e 2007, considerando a frequência das recidivas locais e o tempo para início da radioterapia adjuvante. Resultados As recidivas locais foram diagnosticadas em 54 (35%) pacientes. A radioterapia reduziu a frequência de recidivas locais, embora sem significância estatística. O tempo entre a cirurgia e o início da radioterapia pós-operatória não influenciaram, de forma significante, no risco de recidivas locais entre o pacientes que tinham indicação de tratamento adjuvante (p=0,49). Conclusão Na presença de fatores de risco para recidiva local, um pequeno atraso no início da radioterapia adjuvante não contra-indica sua realização. .