RESUMEN
BACKGROUND: Malignant melanoma (MM) arising in a giant pigmented nevus (GPN) is a rare disease in adults with no large series published to our knowledge. OBJECTIVE: We sought to describe the characteristics, treatment, and survival of MM in GPN for adults. METHODS: Adults with invasive MM in GPN (n = 976) reported to the National Cancer Data Base from 1998 to 2012 were evaluated for patient and tumor characteristics, treatment, and survival. For comparison, data from adults with invasive superficial spreading melanoma (SSM) (n = 111,870) and nodular melanoma (n = 35,962) were used. RESULTS: Compared with patients with SSM, patients with MM in GPN had a thicker Breslow depth, more positive lymph nodes, and distant metastasis more frequently. Multivariate analysis identified age older than 65 years, Breslow thickness greater than 2 mm, presence of ulceration, presence of distant metastasis, and positive margins as independent predictors of survival in patients with MM in GPN. At all stages, having MM in GPN has similar overall survival compared with SSM. LIMITATIONS: The study is retrospective and registry-based. CONCLUSIONS: Invasive MM in GPN occurs in adults, with overall survival similar to SSM. Clinicians should be aware of the continued risk of MM in adults with GPN with low threshold for biopsy.
Asunto(s)
Melanoma/mortalidad , Melanoma/secundario , Neoplasias Primarias Secundarias/mortalidad , Nevo Pigmentado/patología , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Factores de Edad , Anciano , Bases de Datos Factuales , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasia Residual , Neoplasias Primarias Secundarias/patología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Insular thyroid carcinoma (ITC) is a rare but aggressive thyroid malignancy. METHODS: Patients with ITC (n = 508) reported to the National Cancer Data Base from 1998 to 2012 were evaluated for patient, tumor, and treatment characteristics and outcomes. RESULTS: Compared to papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), patients with ITC cancer were older, more often were men, had larger tumors, were more likely to present with distant metastasis, were less likely to have an R0 resection, more likely to receive external beam radiation and chemotherapy, and had significantly worse survival. Multivariate Cox regression identified age >65 years (hazard ratio [HR] = 1.53), presence of at least 1 comorbidity (HR = 1.80), positive lymph nodes (HR = 1.67), the presence of metastasis (HR = 2.73), positive margins (HR = 2.48), and radioactive iodine therapy (HR = 0.63) as significant and independent predictors of survival in ITC. CONCLUSION: Treatment recommendations should incorporate the use of radioactive iodine after complete surgical resection and clearance of involved nodal basins. © 2016 Wiley Periodicals, Inc. Head Neck 38: 906-912, 2016.
Asunto(s)
Neoplasias de la Tiroides/mortalidad , Adulto , Distribución por Edad , Anciano , Bases de Datos Factuales , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Distribución por Sexo , Análisis de Supervivencia , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Estados UnidosRESUMEN
Variations in the course of the recurrent laryngeal nerve (RLN) can occur, including the development of a nonrecurrent inferior laryngeal nerve (NRILN). Rarely, both a right RLN and a right NRILN have been reported in the same patient, merging before they enter the larynx. A case is presented, including images, and the literature concerning this rare anatomical finding is reviewed, including studies suggesting alternative explanations for these cases. Fourteen previously reported cases of coexisting RLN and NRILN were identified, all involving the right side. Some cases were associated with an anomalous origin of the right subclavian artery and some were not. The alternative explanations that a communicating branch of the sympathetic nerve, which joins the RLN, is mistaken for an NRILN or that a collateral branch from an NRILN is mistaken for an RLN in these cases are also considered. Surgeons must be aware of these unusual variations to minimize nerve injury during neck surgery.