RESUMEN
Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor of the jaws, histologically characterized by the presence of agglomerates of cells with eosinophilic cytoplasm. The patient, a 62-year-old Caucasian woman, presented an intraosseous lesion in the mandibular symphysis. A clinical examination revealed a discrete volumetric increase with a hard consistency, palpable to extraoral and intraoral examinations. Imaging studies revealed an extensive radiolucent area, without defined limits, extending from the region of the right second premolar to the left canine. Incisional biopsy analysis indicated a diagnosis of CCOC. The treatment proposed was segmental resection of the mandible with a safety margin. After six months without recurrence, definitive mandibular reconstruction was performed using an iliac crest graft, followed by rehabilitation with implant-supported denture after five months. After three years of post-resection follow-up, the patient has shown no evidence of recurrence or metastasis. She continues to be under follow-up. To conclude, CCOC must be considered a malignant tumor with aggressive behavior. Previous studies have shown that resection with free margins is a treatment with a lower rate of recurrence. Nevertheless, long-term follow-up is necessary for such patients.
Asunto(s)
Adenocarcinoma de Células Claras/cirugía , Neoplasias Mandibulares/cirugía , Tumores Odontogénicos/cirugía , Adenocarcinoma de Células Claras/diagnóstico por imagen , Adenocarcinoma de Células Claras/patología , Biopsia , Trasplante Óseo/métodos , Femenino , Humanos , Ilion/trasplante , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/patología , Osteotomía Mandibular/métodos , Persona de Mediana Edad , Tumores Odontogénicos/diagnóstico por imagen , Tumores Odontogénicos/patología , Radiografía Panorámica , Resultado del TratamientoRESUMEN
Abstract Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor of the jaws, histologically characterized by the presence of agglomerates of cells with eosinophilic cytoplasm. The patient, a 62-year-old Caucasian woman, presented an intraosseous lesion in the mandibular symphysis. A clinical examination revealed a discrete volumetric increase with a hard consistency, palpable to extraoral and intraoral examinations. Imaging studies revealed an extensive radiolucent area, without defined limits, extending from the region of the right second premolar to the left canine. Incisional biopsy analysis indicated a diagnosis of CCOC. The treatment proposed was segmental resection of the mandible with a safety margin. After six months without recurrence, definitive mandibular reconstruction was performed using an iliac crest graft, followed by rehabilitation with implant-supported denture after five months. After three years of post-resection follow-up, the patient has shown no evidence of recurrence or metastasis. She continues to be under follow-up. To conclude, CCOC must be considered a malignant tumor with aggressive behavior. Previous studies have shown that resection with free margins is a treatment with a lower rate of recurrence. Nevertheless, long-term follow-up is necessary for such patients.
Asunto(s)
Humanos , Femenino , Neoplasias Mandibulares/cirugía , Tumores Odontogénicos/cirugía , Adenocarcinoma de Células Claras/cirugía , Biopsia , Radiografía Panorámica , Neoplasias Mandibulares/patología , Neoplasias Mandibulares/diagnóstico por imagen , Tumores Odontogénicos/patología , Tumores Odontogénicos/diagnóstico por imagen , Trasplante Óseo/métodos , Resultado del Tratamiento , Adenocarcinoma de Células Claras/patología , Adenocarcinoma de Células Claras/diagnóstico por imagen , Osteotomía Mandibular/métodos , Ilion/trasplante , Persona de Mediana EdadRESUMEN
BACKGROUND: Salvage surgery is considered the best treatment approach for patients with recurrent oral carcinoma. Unfortunately, 50% to 60% of the patients who undergo salvage surgery will develop further locoregional recurrence, and they are not usually considered for further treatment. Our aim in this study was to report our experience with a second salvage surgery for selected patients with re-recurrent oral cavity and oropharyngeal squamous cell carcinoma (SCC). METHODS: Forty-one patients underwent a second salvage surgical procedure, with curative intention for re-recurrent oral cancer. The surgical treatment used was wide local resection in 34 cases, neck dissection in 9 cases, and isolated neck dissection in 7 cases. RESULTS: Cancer-specific survival (CSS) rate in 3 years was at 20%. Patients with re-recurrence in <6 months presented 3-year CSS null, whereas patients with re-recurrence after 6 months presented 3-year CSS of 32.3% (p = .007). CONCLUSION: Second salvage surgery can be considered a potentially curative therapeutic approach for a selected group of patients with re-recurrent oral SCC. The disease-free interval was the main clinical factor associated with the prognosis.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias Orofaríngeas/cirugía , Terapia Recuperativa , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Reoperación , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyze the prognostic effect of epidermal growth factor receptor (EGFR), matrix metalloproteinases 2 and 9, and vascular endothelial growth factor expression in patients with locally recurrent oral carcinoma after salvage surgery. DESIGN: Retrospective cohort study. Settings Tertiary center cancer hospital. PATIENTS: The charts of 111 patients with local recurrence of oral carcinomas were retrospectively analyzed. The previous treatment consisted of surgery in 33 patients (30.0%), radiotherapy with or without chemotherapy in 46 patients (41.0%), and surgery with adjuvant radiotherapy in 32 patients (29.0%). The expression of EGFR, matrix metalloproteinases 2 and 9, and vascular endothelial growth factor was analyzed with a tissue microarray immunohistochemical technique. MAIN OUTCOME MEASURES: Overall survival and cancer-specific survival (CSS). RESULTS: The recurrences were diagnosed in less than 1 year in 69 patients (62.2%) and in more than 1 year in 42 patients (37.8%). The prognosis was worse in the group with the disease-free interval of less than 1 year (P = .01). Patients with more advanced disease (clinical stage of recurrence, III/IV) had worse rates of CSS (P = .04). Cases that were positive for EGFR had a 3-year CSS of 27.2%, while EGFR-negative cases had a 3-year CSS of 64.3% (P = .001). The expression of matrix metalloproteinases 2 (P = .83) and 9 (P = .15) and vascular endothelial growth factor (P = .86) was not significant in this group. In multivariate analysis, only the disease-free interval and the overexpression of EGFR were associated with a higher risk of cancer death. CONCLUSIONS: Local recurrence in oral carcinomas carries a poor prognosis. A disease-free interval of more than 1 year and a EGFR-negative expression are the main prognostic factors related to better CSS in patients treated with salvage surgery.
Asunto(s)
Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Receptores ErbB/análisis , Neoplasias de los Labios/patología , Neoplasias de los Labios/cirugía , Metaloproteinasa 2 de la Matriz/análisis , Metaloproteinasa 9 de la Matriz/análisis , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/cirugía , Terapia Recuperativa , Factor A de Crecimiento Endotelial Vascular/análisis , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Humanos , Técnicas para Inmunoenzimas , Neoplasias de los Labios/mortalidad , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Neoplasias Orofaríngeas/mortalidad , Pronóstico , Reoperación , Estudios RetrospectivosRESUMEN
BACKGROUND: The aim of this study was to evaluate risk factors of neck recurrence in patients with pN+ necks submitted to a modified or a classic radical neck dissection and the safety of preserving the internal jugular vein in the treatment of a subgroup of these patients. METHODS: The medical records of 311 untreated patients with squamous cell carcinoma of the oral cavity (106 cases), oropharynx (95 cases), larynx (49 cases), and hypopharynx (61 cases) were reviewed. Their clinical stages (CS) were CS II in 1%, CS III in 19.9%, CS IVA in 76.2%, and CS IVB in 19.6% of the cases. All patients were pN+. RESULTS: Ipsilateral neck recurrence occurred in 18 cases (5.8%), 14 cases (4.5%) where the internal jugular vein was resected, and 4 cases (1.3%) where the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .852), T stage (P = .369), N stage (P = .963), adjuvant radiotherapy (P = .701), number of positive lymph nodes (P = .886), jugular vein preservation (P = .240), and extracapsular spread (P = .670). There was significant correlation between neck recurrence and the lymph node size (.040). CONCLUSIONS: Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase in the risk of neck recurrence.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Venas Yugulares , Disección del Cuello , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Procedimientos Quirúrgicos Electivos , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Local and regional recurrences are the main sites of treatment failure in patients with oral and oropharyngeal squamous cell carcinoma. Treatment failure depends fundamentally on tumor biologic behavior, previous treatment and the initial clinical stage. The rates of loco-regional recurrences range from 25 to 48%, and distant metastasis rarely occur in an isolated manner. When recurrent cancer is significant and there are no distant metastasis salvage surgery is the most widely used treatment approach. Most of these patients were previously treated with radiotherapy. Therefore, when recurrence occurs, salvage surgery is the only possible treatment option with curative intent. The aim of this study was to review the data in the literature regarding results of salvage surgical treatment for patients with recurrent oral and oropharyngeal carcinomas
Asunto(s)
Humanos , Boca , Carcinoma , Neoplasias Orofaríngeas/cirugía , Recurrencia Local de Neoplasia/cirugíaRESUMEN
BACKGROUND: Therapeutic decisions in recurrent oral and oropharyngeal squamous carcinoma (SCC) remain controversial. METHODS: Two hundred forty-six consecutive patients who underwent salvage surgery for recurrent squamous cell carcinoma (SCC) of the oral cavity and oropharynx were studied. The tumor sites were lip, 33 cases; oral cavity, 143; oropharynx, 70. The previous treatment was surgery in 73 patients, radiotherapy in 96, combined surgery and radiotherapy in 76, and chemotherapy in one. The clinical stage of recurrence was I/II in 51 cases and III/IV in 195 cases. The disease-free interval (DFI) was less than 1 year in 156 cases and greater than 1 year in 90 cases. RESULTS: The rate of recurrence was 54.9%, and the overall 5-year actuarial survival rate was 32.3%. The significant prognostic factors in multivariate analysis were restage (p = .049) and DFI (p = .045). CONCLUSION: Patients with recurrent oral and oropharyngeal SCC at initial clinical stages (rCS I and II) and with a DFI greater than 1 year had a favorable prognosis.