RESUMEN
BACKGROUND: Carotid blowout syndrome is a severe complication of head and neck cancer, associated with high mortality and morbidity. METHODS: We present a case of acute hemorrhage from the carotid artery of a 59-year-old man with a history of chemoradiotherapy for lingual base and oropharyngeal squamous cell carcinoma. The case was managed by a staged multidisciplinary approach of open arterial reconstruction, after initial endovascular hemorrhage control using stent graft. RESULTS: The patient was discharged to home with patent carotid artery, no sign of infection or bleeding, and autonomous ambulation. A CT/PET scan performed 6 months later confirmed healing and absence of tumor recurrence. CONCLUSIONS: A multidisciplinary approach involving vascular surgeons, ENT surgeons, plastic and maxillofacial surgeons is particularly appropriate in the management of carotid blowout syndrome to warrant a durable and effective repair of all the anatomical structures involved.
Asunto(s)
Implantación de Prótesis Vascular , Traumatismos de las Arterias Carótidas/cirugía , Quimioradioterapia/efectos adversos , Procedimientos Endovasculares , Hemorragia/cirugía , Neoplasias Orofaríngeas/terapia , Traumatismos por Radiación/cirugía , Vena Safena/trasplante , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Traumatismos de las Arterias Carótidas/diagnóstico por imagen , Traumatismos de las Arterias Carótidas/etiología , Procedimientos Endovasculares/instrumentación , Hemorragia/diagnóstico por imagen , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Colgajo Miocutáneo , Neoplasias Orofaríngeas/complicaciones , Neoplasias Orofaríngeas/patología , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/etiología , Carcinoma de Células Escamosas de Cabeza y Cuello/complicaciones , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Stents , Síndrome , Resultado del TratamientoRESUMEN
Head and neck squamous cell carcinomas evade immune response through multiple immunologic resistance mechanisms. Two of the most commonly involved checkpoint inhibitory mechanisms are CTLA-4 and PD-1/PD-L1, which act at earlier and later stages of immune response to tumors. Pembrolizumab and nivolumab are PD-1 antibodies that interrupt the immunosuppressive pathway of inhibitory checkpoints, which are used by tumor cells to prevent immune reaction. Both recently gained US FDA approval for the treatment of patients with recurrent or metastatic head and neck cancer with disease progression during or following platinum containing chemotherapy. No conclusions can be drawn on the role of PD-L1 in identifying patients responding to immunotherapy, given that similar studies lead to contrasting results. It will be crucial to identify predictive markers of immunotherapy response, and to evaluate them prospectively. A better understanding of the complex network between tumor, immune system and other oncologic treatments will help us to develop more efficient multimodality treatments.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/terapia , Inmunoterapia/métodos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antígeno B7-H1/inmunología , Antígeno CTLA-4/inmunología , Carcinoma de Células Escamosas/inmunología , Aprobación de Drogas , Neoplasias de Cabeza y Cuello/inmunología , Humanos , Nivolumab , Receptor de Muerte Celular Programada 1/inmunología , Escape del TumorRESUMEN
Although recurrent respiratory papillomatosis is a benign disease of the upper aerodigestive tract caused by infection with human papillomavirus, the disease process is unpredictable, ranging from mild disease and spontaneous remission to an aggressive disease with pulmonary spread and requirement for frequent surgical debulking procedures. It can present a protracted clinical course and cause potentially life-threatening compromise of the airways. Over recent decades, a number of alternative medical therapies to standard surgical treatment have been investigated, with modest outcomes overall. Currently, some additional therapies are being explored, together with novel surgical instrumentation that can help to avoid inevitable long-term stenotic complications, ultimately affecting quality of life. Hopefully, clinicians might soon be able to significantly improve the quality of treatment and outcomes for patients affected with recurrent respiratory papillomatosis, with human papillomavirus vaccination having a potentially important role.
Asunto(s)
Neoplasias de Cabeza y Cuello/epidemiología , Sarcoma/epidemiología , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: PEComas (perivascular epithelioid cell tumors) are a family of neoplastic lesions that share overlapping ultrastructure and morphological and immunohistochemical appearance and include angiomyolipoma, lymphangioleiomyomatosis, and clear cell "sugar" tumor of the lung, as well as similar tumors that occur in a variety of visceral, cutaneous, and soft tissue sites throughout the body. METHODS: A 40-year-old woman came to medical attention because of epistaxis and because of unilateral nasal obstruction of 3 months' duration. Endoscopic examination revealed a well-demarcated exophytic lesion attached to the anterior portion of the middle turbinate. RESULTS: The lesion was superficially located, and therefore amenable to complete surgical excision. Seven years after surgery, the patient is alive and well, without evidence of local recurrence or metastastic disease. Based on morphological and immunohistochemical appearance, a diagnosis of PEComa with worrisome histologic features was rendered. CONCLUSIONS: In the present study, we describe a PEComa that occurred in the nasal cavity and discuss the behavior of this entity. The importance of recognizing this disease will ensure its consideration in the differential diagnosis of tumors of the head that have similar morphological features. The histogenesis of PEComa still remains elusive, and collection of additional cases with a prolonged follow-up will be important in accurately determining the behavior of these distinctive tumors.
Asunto(s)
Cavidad Nasal/patología , Estadificación de Neoplasias , Neoplasias Nasales/patología , Neoplasias de Células Epitelioides Perivasculares/patología , Adulto , Biopsia , Progresión de la Enfermedad , Endoscopía , Femenino , Estudios de Seguimiento , HumanosAsunto(s)
Adenoma/patología , Células Oxífilas/patología , Neoplasias de las Glándulas Salivales/patología , Adenoma/diagnóstico , Tejido Adiposo/patología , Anciano , Proliferación Celular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glándula Parótida/patología , Neoplasias de las Glándulas Salivales/diagnóstico , Glándula Submandibular/patologíaRESUMEN
OBJECTIVES: The study was performed to evaluate the prognostic relevance of cell proliferation associated with Ki-67/ Mib-1 immunostaining in malignant tumors of the major salivary glands. METHODS: Cell proliferation was evaluated by Mib-1 antibody against Ki-67 antigen in 41 patients with cancer of the parotid or submandibular glands, including 14 acinic cell carcinomas, 12 ductal carcinomas, 7 mucoepidermoid carcinomas, 5 carcinomas ex pleomorphic adenoma, 1 adenoid cystic carcinoma, 1 undifferentiated carcinoma, and 1 polymorphous low-grade adenocarcinoma. RESULTS: Patients with Ki-67 values of more than 15% and those with Ki-67 values of 15% or less differed both in disease-free survival (p < 0.001) and in overall survival (p < 0.001). We evaluated the association between Ki-67 and time to recurrence in correlation to age, sex, ductal histotype, and N stage; the Cox regression model was significant (p = 0.013). In the group of patients with T1 and T2 cancers, those with Ki-67 values of 15% or less had better survival rates than did those with Ki-67 values of more than 15% (p = 0.004). In the group of patients with N0 cancers, those with Ki-67 values of 15% or less had a better survival than did those with Ki-67 values of more than 15% (p < 0.001). CONCLUSIONS: To our knowledge, this is the first study to stratify different risk classes in early T1-T2 or N0 malignant tumors of the major salivary glands that identified aggressive lesions with elevated Ki-67 expression at an initial stage.
Asunto(s)
Antígeno Ki-67/análisis , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/análisis , Carcinoma de Células Acinares/mortalidad , Carcinoma Adenoide Quístico/mortalidad , Carcinoma Ductal/mortalidad , Carcinoma Mucoepidermoide/mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Neoplasias de la Parótida/mortalidad , Pronóstico , Neoplasias de las Glándulas Salivales/mortalidad , Neoplasias de la Glándula Submandibular/mortalidadRESUMEN
OBJECTIVE: To describe a case of thyroglossal duct cyst carcinoma that arose in a patient with right thyroid lobe hemiagenesis. METHODS: We present the imaging, physical examination findings, treatment, and clinical course of the study patient. RESULTS: A 35-year-old woman was evaluated for a neck mass that had been present for 6 months and was slowly growing. She reported a previous diagnosis of right hemithyroid agenesis. The patient's preoperative workup included ultrasonography of the neck and head and neck T1- and T2-weighted magnetic resonance imaging, which showed right hemithyroid agenesis and a cystic lesion in the median region of the neck below the hyoid bone. Findings from chest x-rays and thyroid function tests were normal. The patient underwent a modified Sistrunk procedure that included removal of the median portion of the hyoid bone. Histologic findings showed a 2.5-cm thyroglossal duct cyst with a 0.6-cm focus of follicular variant of papillary carcinoma with invasion of the cyst wall. Total thyroidectomy was not performed because of the absence of tumoral invasion of the parenchyma around the thyroglossal duct cyst and because the patient was at low risk for aggressive disease. Cervical ultrasonography examinations were performed 6, 12, and 24 months after treatment, and all findings were normal. Presently, the patient is symptom-free after 4 years of follow-up and has no evidence of disease. CONCLUSION: Incidentally discovered, well-differentiated thyroid cancer that is confined to a thyroglossal duct cyst in a patient at low risk for aggressive disease can be adequately treated by a modified Sistrunk procedure that includes the median portion of the hyoid bone.
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Carcinoma Papilar/cirugía , Quiste Tirogloso/cirugía , Disgenesias Tiroideas/cirugía , Neoplasias de la Tiroides/cirugía , Adulto , Carcinoma Papilar/patología , Femenino , Humanos , Quiste Tirogloso/patología , Disgenesias Tiroideas/patología , Glándula Tiroides/anomalías , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/patología , Resultado del TratamientoRESUMEN
CONCLUSIONS: Our results confirm that supracricoid laryngectomies (SL) are reliable techniques for glottosupraglottic tumors, even for selected T3 and T4 cases, if the indications are correct. These surgical techniques allow a good quality of life with the preservation of the larynx. OBJECTIVE: SL with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP) have been popular over the last 20 years for the treatment of the glottic and/or supraglottic squamous cell carcinoma due to demonstrated good oncological and functional results. We report our experience with these techniques, with special focus on long-term oncological and functional results. PATIENTS AND METHODS: We retrospectively reviewed 206 patients who had undergone SL with CHEP or CHP technique between 1987 and 1998 for glottosupraglottic squamous cell carcinoma in our department. The long-term results for 206 patients with T1-T4 laryngeal carcinomas treated with SL are reported: 90.8% CHEP and 9.2% CHP. The mean follow-up was 62 months. RESULTS: Oncological results: the 5-year actuarial disease-free survival was 85%; the 5-year determinate actuarial survival was 88.3%. Functional results: organ preservation rate was 97%. Phonation was assessed according to the GRBAS scale.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Cartílago Cricoides/cirugía , Epiglotis/cirugía , Hueso Hioides/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Fonación/fisiología , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Supervivencia sin Enfermedad , Epiglotis/patología , Femenino , Humanos , Hueso Hioides/patología , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
Bronchogenic cysts are rare congenital malformations of ventral foregut development. They are usually located in the mediastinum and intrapulmonary regions. Localization in the cervical area is unusual and the majority of cases reported have been found in the pediatric population: the literature reports few cases in adults. We describe a 57-year-old male who presented an asymptomatic right lateral neck mass. Diagnostic studies included chest X-ray, pharyngo-esophagus double-contrast X-ray, computed tomography (CT), and bronchoscopy. The mass was excised through a transverse right cervical skin incision. The right lateral neck mass of the patient was identified as a bronchogenic cyst. The embryology, the presentation, the pathological and radiological evaluation, treatment of the cyst and a review of the English literature are reported in this paper. Cervical bronchogenic cysts are usually diagnosed in the pediatric population; these lesions are rare in adults. We suggest that the clinical observation of an asymptomatic lateral neck mass in an adult should include the possibility of a bronchogenic cyst in the differential diagnosis. Surgical excision is the elective treatment for this tumor, in order to prevent complications including infection, compression symptoms, malignant transformation, and the rare but fatal air embolism.