RESUMEN
El carcinoma oral de células escamosas o epidermoide o espinocelular, es la neoplasia maligna más común en cavidad oral y orofaringe, representa de 3-5% de todas las neoplasias y da metástasis a los ganglios linfáticos regionales. Los factores de riesgos son múltiples, el consumo excesivo de alcohol y tabaco son los más reconocidos, los movimientos parafuncionales, la higiene y nutrición y por supuesto la genética, todos son factores importantes en el desarrollo de este carcinoma. Tiene una prevalencia mayor en el sexo masculino, aunque en los últimos años se ha visto un aumento en el sexo femenino posiblemente por el aumento en el consumo de alcohol y tabaco. La edad comprende entre la cuarta a sexta década de la vida, por el aumento en el consumo de alcohol y tabaco en este rango de edad. Las localizaciones más comunes son el borde lateral de la lengua y el piso de la boca. La presentación clínica es variable, puede encontrarse en un principio como una placa blanca o roja asintomática, exofítico, ulcerada, granular y bordes indurados. El tratamiento debe ser quirúrgico radical con radio o quimioterapia y el pronóstico depende del tiempo del diagnóstico (AU)
Squamous cell carcinoma, also known as epidermoid or squamous cell carcinoma, is the most common malignant neoplasm in the oral cavity and oropharynx. It represents 3 to 5% of all neoplasms and metastasizes to regional lymph nodes. There are multiple risk factors, with excessive alcohol and tobacco consumption being the most recognized. Parafunctional movements, hygiene and nutrition, and of course genetics, are all important factors in the development of this carcinoma. It has a higher prevalence in males, although in recent years there has been an increase in females, possibly due to increased alcohol and tobacco consumption. The age range typically affected is the 4th to 6th decade of life, due to the increased alcohol and tobacco consumption within this age range. The most common locations are the lateral border of the tongue and the floor of the mouth. The clinical presentation varies and can initially appear as an asymptomatic white or red plaque, exophytic, ulcerated, granular, or with indurated borders. The treatment should involve radical surgery with radiotherapy or chemotherapy, and the prognosis depends on the timing of diagnosis (AU)
Asunto(s)
Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas/cirugía , Proceso Alveolar/patología , Biopsia/métodos , Carcinoma de Células Escamosas/diagnóstico por imagen , Factores de Riesgo , Distribución por Edad y SexoAsunto(s)
Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Esofagoscopía , Humanos , Neoplasias Esofágicas/terapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/diagnóstico por imagen , Carcinoma de Células Escamosas de Esófago/terapia , Carcinoma de Células Escamosas de Esófago/patología , Carcinoma de Células Escamosas de Esófago/diagnóstico , Esofagoscopía/métodos , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patologíaRESUMEN
Segmentation of tumor regions in H &E-stained slides is an important task for a pathologist while diagnosing different types of cancer, including oral squamous cell carcinoma (OSCC). Histological image segmentation is often constrained by the availability of labeled training data since labeling histological images is a highly skilled, complex, and time-consuming task. Thus, data augmentation strategies become essential to train convolutional neural networks models to overcome the overfitting problem when only a few training samples are available. This paper proposes a new data augmentation strategy, named Random Composition Augmentation (RCAug), to train fully convolutional networks (FCN) to segment OSCC tumor regions in H &E-stained histological images. Given the input image and their corresponding label, a pipeline with a random composition of geometric, distortion, color transfer, and generative image transformations is executed on the fly. Experimental evaluations were performed using an FCN-based method to segment OSCC regions through a set of different data augmentation transformations. By using RCAug, we improved the FCN-based segmentation method from 0.51 to 0.81 of intersection-over-union (IOU) in a whole slide image dataset and from 0.65 to 0.69 of IOU in a tissue microarray images dataset.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de la Boca , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de la Boca/diagnóstico por imagen , Redes Neurales de la ComputaciónAsunto(s)
Carcinoma de Células Escamosas , Encefalitis , Neoplasias de la Lengua , Humanos , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Neoplasias de la Lengua/complicaciones , Neoplasias de la Lengua/diagnóstico por imagen , Neoplasias de la Lengua/patología , Lengua/patologíaRESUMEN
OBJECTIVE: Oral Squamous Cell Carcinoma (OSCC) is conventionally treated by surgical resection, and positive surgical margins strongly increase local recurrence and decrease survival. This study aimed to evaluate whether a Three-Dimensional Segmentation (3DS) image of OSCC confers advantage over Multiplanar Reconstruction (MPR) of OSCC using images of computed tomography scan in surgical planning of tumor resection. METHODS: Twenty-six patients with locally advanced OSCC had tumor morphology and dimensions evaluated by MPR images, 3DS images, and Surgical Pathology Specimen (SPS) analyses (gold standard). OSCC resection was performed with curative intent using only MPR images. RESULTS: OSCC morphology was more accurately assessed by 3DS than by MPR images. Similar OSCC volumes and dimensions were obtained when MPR images, 3DS images and SPS measurements were considered. Nevertheless, there was a strong correlation between the OSCC longest axis measured by 3DS and SPS analyses (ICCâ¯=â¯0.82; 95% CI 0.59â0.92), whereas only a moderate correlation was observed between the longest axis of OSCC measured by MPR images and SPS analyses (ICCâ¯=â¯0.51; 95% CI 0.09â0.78). Taking only SPS with positive margins into account, MPR images and 3DS images underestimated the tumor's longest axis in eight out of 11 (72.7%) and 5 out of the 11 (45.5%) cases, respectively. CONCLUSION: Our data present preliminary evidence that 3DS model represents a useful tool for surgical planning of OSCC resection, but confirmation in a larger cohort of patients is required. LEVEL OF EVIDENCE: Laboratory study.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Humanos , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/cirugía , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas de Cabeza y Cuello , Proyectos Piloto , Imagenología Tridimensional/métodos , Márgenes de Escisión , Recurrencia Local de Neoplasia/patologíaRESUMEN
OBJECTIVE: To evaluate the prognostic impact of clinical and pathological variables and patterns of recurrence in patients with locally advanced cervical cancer with pelvic lymph node involvement (stage IIIC1 according to the 2018 FIGO Staging System). METHODS: We retrospectively analyzed 62 patients with locally advanced cervical cancer treated with curative intent with radiotherapy associated with chemotherapy in AC Camargo Cancer Center from January 2007 to December 2018. RESULTS: Lymph node involvement was assessed by CT, MRI and positron emission tomography (PET)/CT in 28 (45.2%), 20 (32.3%) and 14 (22.6%) patients, respectively. The median tumor size was 5.0 cm and 72.6% of cases were squamous cell carcinomas. The median number of positive pelvic lymph nodes was three, and the median size of lymph nodes was 24 mm. Twenty-two (35.5%) patients had recurrence and 50% had only one site of recurrence. The sites of recurrence were pelvic, para-aortic and distant in 12 (19.4%), 6 (9.7%) and 16 (25.8%) patients, respectively. The 3 year overall and disease-free survival were 70.8% and 64.6%, respectively. Patients with adenocarcinoma had worse disease-free survival (HR 2.38; 95% CI 1.01 to 5.60; p=0.047) and overall survival (HR 2.99; 95% CI 1.14 to 7.75; p=0.025) compared with squamous cell carcinoma. In multivariate analysis, metastatic pelvic lymph node size of >2.5 cm (HR 4.38; 95% CI 1.65 to 11.6; p=0.003) and incomplete response to radiotherapy (HR 5.14; 95% CI 1.60 to 16.4; p=0.006) maintained the negative impact for overall survival. CONCLUSIONS: We found that pelvic lymph node size and incomplete response to radiotherapy negatively impact overall survival in patients with advanced cervical cancer with pelvic lymph node involvement. This finding may help to stratify risk in this group of patients.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias del Cuello Uterino , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/radioterapia , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/radioterapiaRESUMEN
PURPOSE: To evaluate prevalence and diagnostic performance of three colposcopic images to diagnose squamous and glandular cervical precursor neoplasias. METHODS: Cross-sectional study, conducted through analysis of stored digital colposcopic images. To evaluate the diagnostic performance of three images, herein named grouped glands, aceto-white villi, and atypical vessels, for detection of adenocarcinoma in situ (AIS) and cervical squamous intraepithelial neoplasias (CIN) grades 2 and 3, calculations of sensitivity, specificity, accuracy, positive likelihood ratio, receiver operating characteristic (ROC) curve, and area under the curve (AUC) were made, with their respective 95% confidence intervals. RESULTS: Grouped glands, aceto-white villi, and atypical vessels images had: prevalence of 21.3, 53.8, and 33.8% in patients with AIS, and 16.2, 19.5, and 9.3% in those with CIN 2 and 3; for the diagnosis of AIS, sensitivity of 21.3, 53.8, and 33.8%, specificity of 89.8, 95.2, and 94.9%, accuracy of 76.6, 87.2, and 83.1%, positive likelihood ratio of 2.1, 11.2, and 6.6, and AUC of 0.55, 0.74, and 0.64; for the diagnosis of CIN 2 and 3, sensitivity of 16.2, 19.5, and 9.3%, specificity of 89.8, 95.2, and 94.9%, accuracy of 39.4, 43.4, and 36.3%, positive likelihood ratio of 1.6, 4.1, and 1, 8, and AUC of 0.53, 0.57, and 0.52, respectively. CONCLUSION: Prevalence and accuracy of the three images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias. Sensitivity, specificity, positive likelihood, and AUC of aceto-white villi and atypical vessels images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias Glandulares y Epiteliales , Neoplasias del Cuello Uterino , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Cuello del Útero/diagnóstico por imagen , Cuello del Útero/patología , Colposcopía , Estudios Transversales , Femenino , Humanos , Neoplasias Glandulares y Epiteliales/patología , Embarazo , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/patología , Frotis VaginalRESUMEN
Primary squamous cell carcinoma of the colon is extremely rare. The etiology is poorly understood, and currently, there are different hypotheses about the origin of this malignant neoplasm. Here, we report a case of an 87-year-old male with a moderately-differentiated nonkeratinizing squamous cell carcinoma of the colon.
Asunto(s)
Carcinoma de Células Escamosas , Colon Sigmoide , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico por imagen , Colon , Colon Sigmoide/diagnóstico por imagen , Humanos , MasculinoAsunto(s)
Adenocarcinoma/patología , Carcinoma de Células Escamosas/patología , Neoplasias del Cuello Uterino/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/terapia , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/terapia , Cesárea , Femenino , Edad Gestacional , Humanos , Histerectomía , Imagen por Resonancia Magnética , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico , Complicaciones Neoplásicas del Embarazo/patología , Complicaciones Neoplásicas del Embarazo/terapia , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/terapiaAsunto(s)
Carcinoma de Células Escamosas/patología , Escisión del Ganglio Linfático/métodos , Neoplasias del Cuello Uterino/patología , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Conización , Femenino , Humanos , Imagen por Resonancia Magnética , Estadificación de Neoplasias , Embarazo , Embarazo Gemelar , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/cirugíaRESUMEN
Abstract Introduction: Head and neck squamous cell carcinoma is the seventh most common malignant tumor. The advances in treatment have improved the global survival rates in the past years, although the prognosis is still grave. Objective: The aim of the present study is to evaluate the correlation between positron emission computed tomography and computed tomography at the time of staging a previously untreated head and neck squamous cell carcinoma, and to determine which of the two imaging techniques gives us more information at the time of initial diagnosis. Methods: Data from all patients diagnosed in our hospital of head and neck squamous cell carcinoma by a biopsy of any location or unknown primary tumor was collected, between January 2012 and July 2017. In all cases, computed tomography and positron emission computed tomography were performed with a maximum of 30 days difference between them and patients had not received any prior treatment to staging. The stage given to each case was compared based solely on the physical examination, only on the computed tomography/positron emission computed tomography, with respect to the stage given by the tumor board, observing the concordance obtained through Cramer's V statistical test. Results: We performed a comparative analysis obtaining a correlation of 0.729 between the stage given by the tumor board and the one assigned based on the physical examination without imaging techniques. When only using computed tomography as an imaging method, the correlation was 0.848, whereas with only the use of positron emission computed tomography it was estimated at 0.957. When comparing the statistical association between staging using exclusively one of the two imaging techniques, correlation was 0.855. Conclusion: Positron emission computed tomography is useful for the diagnosis of head and neck squamous cell carcinoma, improving the patient's staging especially when detecting cervical and distant metastases. Therefore, we consider that the use of positron emission computed tomography for the staging of patients with head and neck squamous cell carcinoma is a diagnostic test to be considered.
Resumo Introdução: O carcinoma espinocelular de cabeça e pescoço é o sétimo tumor maligno mais comum. Os avanços no tratamento melhoraram as taxas de sobrevida global nos últimos anos, embora o prognóstico ainda seja grave. Objetivo: Avaliar a correlação entre a tomografia computadorizada por emissão de pósitrons e a tomografia computadorizada no estadiamento de carcinomas espinocelulares da cabeça e pescoço não tratados previamente e verificar qual das duas técnicas de imagem nos fornece mais informações no momento do diagnóstico inicial. Método: Os dados de todos os pacientes diagnosticados em nosso hospital com carcinoma espinocelular de cabeça e pescoço por biópsia de qualquer região ou adenopatias de origem desconhecida foram colhidos no período entre janeiro de 2012 e julho de 2017. Em todos os casos, uma tomografia computadorizada e uma tomografia computadorizada por emissão de pósitrons foram realizadas com um máximo de 30 dias de diferença entre elas. Nenhum paciente deveria ter recebido tratamento antes do estadiamento. O estadiamento atribuído a cada caso foi comparado com base apenas no exame físico, pela tomografia computadorizada ou apenas pela tomografia computadorizada por emissão de pósitrons, com relação ao estadiamento concedido pela margem tumoral, observou-se a concordância obtida pelo teste estatístico de V de Cramer. Resultado: Realizamos a análise comparativa obtendo uma correlação de 0,729 entre o estadio concedido pela margem tumoral e aquele atribuído com base no exame físico sem técnicas de imagem. Usando apenas a tomografia computadorizada como método de imagem, a correlação foi de 0,848, enquanto que a correlação com a tomografia computadorizada por emissão de pósitrons foi estimada em 0,957. Ao comparar a associação estatística entre o estadiamento usando exclusivamente uma das duas técnicas de imagem, foi de 0,855. Conclusão: Tomografia computadorizada por emissão de pósitrons é útil para o diagnóstico de carcinoma espinocelular de cabeça e pescoço, melhora o estadiamento, especialmente na detecção de metástases cervicais e à distância. Portanto, concluimos que seu uso para o estadiamento de pacientes com carcinoma espinocelular de cabeça e pescoço é um exame diagnóstico a ser considerado.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Sensibilidad y Especificidad , Radiofármacos , Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Estadificación de NeoplasiasRESUMEN
A 75-year-old man was hospitalised for bronchoscopy with biopsy due to a suspicious pulmonary mass at chest tomography. He had significant dyspnoea, constipation, nausea, vomiting, anorexia and a 33% loss of weight in the past 3 months. Biopsy revealed a pulmonary squamous cell carcinoma, which was inoperable. Tramadol used at home for 3 months was replaced by morphine on admission. The patient remained constipated despite prokinetics and laxatives, leading to the diagnostic hypothesis of paraneoplastic motility disorder and opioid-induced constipation. Abdominal tomography ruled out the possibility of mechanical obstruction. As complications, the patient presented superior vena cava syndrome and opioid (morphine) intoxication. The patient died a few days later. The management of this case highlights the importance of multidisciplinary care and the challenges of palliative oncology care. Paraneoplastic motility disorder must always be considered among the mechanisms of intestinal dysfunction in patients with advanced oncological disease.
Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Estreñimiento/etiología , Gastroparesia/etiología , Neoplasias Pulmonares/complicaciones , Síndromes Paraneoplásicos del Sistema Nervioso/etiología , Anciano , Antieméticos/uso terapéutico , Carcinoma de Células Escamosas/diagnóstico por imagen , Estreñimiento/diagnóstico , Estreñimiento/tratamiento farmacológico , Estreñimiento/fisiopatología , Fármacos Gastrointestinales/uso terapéutico , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/tratamiento farmacológico , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/fisiopatología , Motilidad Gastrointestinal , Gastroparesia/diagnóstico , Gastroparesia/tratamiento farmacológico , Gastroparesia/fisiopatología , Glicerol/uso terapéutico , Humanos , Lactulosa/uso terapéutico , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Metoclopramida/análogos & derivados , Metoclopramida/uso terapéutico , Morfina/efectos adversos , Estreñimiento Inducido por Opioides/diagnóstico , Cuidados Paliativos , Síndromes Paraneoplásicos del Sistema Nervioso/diagnóstico , Síndromes Paraneoplásicos del Sistema Nervioso/fisiopatología , Tramadol/efectos adversosRESUMEN
INTRODUCTION: Head and neck squamous cell carcinoma is the seventh most common malignant tumor. The advances in treatment have improved the global survival rates in the past years, although the prognosis is still grave. OBJECTIVE: The aim of the present study is to evaluate the correlation between positron emission computed tomography and computed tomography at the time of staging a previously untreated head and neck squamous cell carcinoma, and to determine which of the two imaging techniques gives us more information at the time of initial diagnosis. METHODS: Data from all patients diagnosed in our hospital of head and neck squamous cell carcinoma by a biopsy of any location or unknown primary tumor was collected, between January 2012 and July 2017. In all cases, computed tomography and positron emission computed tomography were performed with a maximum of 30 days difference between them and patients had not received any prior treatment to staging. The stage given to each case was compared based solely on the physical examination, only on the computed tomography/positron emission computed tomography, with respect to the stage given by the tumor board, observing the concordance obtained through Cramer's V statistical test. RESULTS: We performed a comparative analysis obtaining a correlation of 0.729 between the stage given by the tumor board and the one assigned based on the physical examination without imaging techniques. When only using computed tomography as an imaging method, the correlation was 0.848, whereas with only the use of positron emission computed tomography it was estimated at 0.957. When comparing the statistical association between staging using exclusively one of the two imaging techniques, correlation was 0.855. CONCLUSION: Positron emission computed tomography is useful for the diagnosis of head and neck squamous cell carcinoma, improving the patient's staging especially when detecting cervical and distant metastases. Therefore, we consider that the use of positron emission computed tomography for the staging of patients with head and neck squamous cell carcinoma is a diagnostic test to be considered.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/terapia , Humanos , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Sensibilidad y Especificidad , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: The prognosis of patients with Oral squamous cell carcinoma (OSCC) are directly related to the stage of development of the tumor at the time of diagnosis, but it is estimated an average delay in diagnosis of 2-5 months. New non-invasive techniques for the early diagnosis of OSCC are being developed, such as methodologies to detect spectral changes of tumor cells. We conducted a systematic review to analyze the potential use of autofluorescence and/or fluorescent probes for OSCC diagnosis. MATERIAL AND METHODS: Four databases (PubMed, Scopus, Embase and Web of Science) were used as research sources. Protocol was registered with PROSPERO. It was included studies that evaluated tissue autofluorescence and/or used fluorescent probes as a method of diagnosing and/or treatment of oral cancer in humans. RESULTS: Forty-five studies were selected for this systematic review, of which 28 dealt only with autofluorescence, 18 on fluorescent probes and 1 evaluated both methods. The VELscope® was the most used device for autofluorescence, exhibiting sensitivity (33%-100%) and specificity (12%-88.6%). 5-Aminolevulinic acid (5-ALA) was the most used fluorescent probe, exhibiting high sensitivity (90%-100%) and specificity (51.3%-96%). Hypericin, rhodamine 6 G, rhodamine 610, porphyrin and γ-glutamyl hydroxymethyl rhodamine green have also been reported. CONCLUSION: Thus, the autofluorescence and fluorescent probes can provide an accurate diagnosis of oral cancer, assisting the dentist during daily clinical activity, but it is not yet possible to suggest that this method may replace histopathological examination.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de la Boca , Fotoquimioterapia , Carcinoma de Células Escamosas/diagnóstico por imagen , Detección Precoz del Cáncer , Colorantes Fluorescentes , Humanos , Neoplasias de la Boca/diagnóstico por imagen , Fotoquimioterapia/métodos , Fármacos FotosensibilizantesRESUMEN
Percutaneous endoscopic gastrostomy is used to provide enteral nutritional support for patients with obstructive oropharyngeal or esophageal neoplasms. The placement of the catheter is considered safe, with few complications. Despite this, a specific complication that is considered rare, has been increasingly described in the literature, i.e., metastasis of head and neck cancer in the gastrostomy stoma. In this report, we described a case of metastasis of squamous cell carcinoma of the larynx in the gastrostomy site, and discussed the possible etiologies and alternatives, seeking to reduce the incidence of this complication.
Asunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias Esofágicas/patología , Gastrostomía/efectos adversos , Neoplasias de Cabeza y Cuello/patología , Neoplasias Laríngeas/patología , Neoplasias Orofaríngeas/patología , Neoplasias Gástricas/secundario , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/terapia , Nutrición Enteral/efectos adversos , Neoplasias de Cabeza y Cuello/terapia , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Neoplasias Gástricas/cirugíaAsunto(s)
Carcinoma de Células Escamosas/cirugía , Escisión del Ganglio Linfático/métodos , Neoplasias del Cuello Uterino/cirugía , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico por imagen , Complicaciones Neoplásicas del Embarazo/patología , Complicaciones Neoplásicas del Embarazo/cirugía , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/patologíaRESUMEN
In an asymptomatic 77-yearold woman, former 55 packyears smoker, a routine X-ray showed a 45-mm superior left lobe lesion. A chest CT scan confirmed a 36-mm superior left lobe lesion and an aortic-pulmonary lymph node enlargement measuring 42 mm, suspicious for neoplasia. A PET-CT scan showed an elevated uptake in the primary lesion, in the aortic-pulmonary lymph node, and in the left hilar lymph node with a standardized uptake value - 40 and 4.3, respectively. CT-guided lung biopsy showed a lung squamous cell carcinoma. An endobronchial ultrasound-guided transbronchial needle aspiration for lymph-node staging was negative for lymph node spread. Brain MRI was negative. Final staging was determined to be a IIIA (T2bN2) squamous cell carcinoma of the lung.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Carcinoma de Células Escamosas/terapia , Infecciones por Coronavirus/diagnóstico , Neoplasias Pulmonares/terapia , Neumonía Viral/diagnóstico , Neumonía/diagnóstico , Anciano , Anticuerpos Monoclonales/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Betacoronavirus , COVID-19 , Carboplatino/administración & dosificación , Carcinoma de Células Escamosas/diagnóstico por imagen , Quimioradioterapia , Quimioterapia de Consolidación , Diagnóstico Diferencial , Femenino , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Paclitaxel/administración & dosificación , Pandemias , Neumonía/inducido químicamente , SARS-CoV-2RESUMEN
Resumen En adultos, una masa cervical detectada mediante examen físico o un estudio de imagen puede ser la única manifestación de un cáncer proveniente de cabeza y cuello. Un retraso en el diagnóstico repercute en el pronóstico de la enfermedad, por lo que debe haber un alto índice de sospecha. Las metástasis cervicales con primario desconocido (MCCPD) son tumores metastásicos en los que el estudio diagnóstico no logró identificar el sitio primario del cáncer, con una histología predominantemente de tipo escamosa. Según algunos estudios, el origen más frecuente resultó ser la orofaringe, incluyendo amígdala palatina y base de lengua. Factores de riesgo conocidos son edades avanzadas, consumo de tabaco y de alcohol. Actualmente, la infección por el virus del papiloma humano (VPH) está teniendo un rol cada vez más importante como factor de riesgo, formando parte de entre 20%-25% de los cánceres de cabeza y cuello. Al enfrentarse a un paciente con masa cervical es importante realizar una completa anamnesis y examen físico acucioso para detectar cualquier elemento sugerente de malignidad. Se debe complementar con nasofibroscopía para visualizar estructuras que no alcanzan a evaluarse en el examen habitual. También se puede orientar la búsqueda del primario desconocido en base a los patrones de drenaje linfático. Dentro del estudio complementario se puede comenzar con una tomografía computada (TC) y se puede considerar también el ultrasonido o un PET/TC. Si con esto aún no se logra definir el primario, continuar con una punción aspirativa con aguja fina (PAAF), luego biopsia core que consiste en tomar una muestra del centro de la lesión guiada por ecografía, si fuese necesario, incluyendo inmunohistoquímica para VPH; ambos estudios histológicos son preferibles en vez de una biopsia abierta debido al menor riesgo de diseminación y complicaciones. El siguiente paso incluye estudio endoscópico y biopsias bajo anestesia. El tratamiento de los pacientes con MCCPD, va a depender de factores relacionados con el estadio de la enfermedad: desde cirugía o radioterapia (RT) únicas, cirugía más RT, y en algunos casos quimioterapia. Se recomienda seguimiento clínico frecuente durante los primeros años y con imágenes dentro de los 6 primeros meses postratamiento.
Abstract In adults, a cervical mass detected by physical examination or an imaging study may be the only manifestation of cancer from the head and neck. A delay in the diagnosis affects the prognosis of the disease, so there must be a high index of suspicion. Cervical metastases from unknown primary tumor (CUP) are metastatic tumors in which the diagnostic study failed to identify the primary site of cancer, with predominantly squamous histology. According to some studies, the most frequent origin was the oropharynx, including palatine tonsil and tongue base. Known risk factors are advanced ages, tobacco and alcohol consumption. Currently, human papilloma virus (HPV) infection is playing an increasingly important role as a risk factor, being the cause of between 20-25% of cancers of the head and neck. When confronting a patient with cervical mass it is important to carry out a complete anamnesis and a thorough physical examination to detect any element suggestive of malignancy. Physical examination could be complemented with a flexible nasal endoscopic to evaluate structures that can not be evaluated in the habitual examination. The search for the unknown primary can also be oriented based on lymphatic drainage patterns. Within the complementary evaluations, one can start with a study of images such as computed tomography (CT) or magnetic resonance imaging (MRI) with contrast, and also could consider ultrasound or PET/CT. If the primary can not be defined yet, fine needle aspiration (FNAP) can be the next choice and then a core biopsy that consisting of taking a sample from the center of the ultrasound-guided lesion, if necessary, including immunohistochemistry for HPV; both histological studies are preferable to an open biopsy because of the lower risk of complications. The next step searching for the primary includes endoscopic study and biopsies under anesthesia. Regarding to the management of patients with CUP, it will depend on factors related to the stage of the disease: from surgery or radiotherapy (RT) only, surgery and RT, and in some cases chemotherapy. Frequent clinical follow-up is recommended during the first years and images within the first 6 months after treatment.
Asunto(s)
Humanos , Neoplasias Primarias Desconocidas/patología , Carcinoma de Células Escamosas/secundario , Neoplasias de Cabeza y Cuello/patología , Neoplasias Primarias Desconocidas , Neoplasias Primarias Desconocidas/radioterapia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Biopsia con Aguja Fina , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , CuelloAsunto(s)
Carcinoma de Células Escamosas/patología , Reflujo Gastroesofágico/complicaciones , Metaplasia/patología , Estómago/diagnóstico por imagen , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Endoscopía , Humanos , Masculino , Metaplasia/cirugíaRESUMEN
Introducción: Se denomina como cáncer de pulmón a un conjunto de enfermedades resultantes del crecimiento aberrante de células del tracto respiratorio, en particular del tejido pulmonar. Objetivo: Determinar los aspectos broncoscópicos e histológicos útiles en la confirmación del diagnóstico de dichas neoplasias malignas. Métodos: Se realizó una investigación descriptiva y transversal de los 346 pacientes atendidos por cáncer de pulmón en el Servicio de Neumología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba durante los años 2016 y 2017, en quienes se realizó broncoscopia. Para ello se utilizaron las variables edad, sexo, técnica diagnóstica empleada, diagnóstico histopatológico, localización más frecuente. Resultados: Predominaron los pacientes en las edades entre los 56 y 75 años (66,1 %), así como el sexo masculino (65,0 %). La biopsia bronquial fue el procedimiento que mayormente reveló la presencia del cáncer (61,3 %) y el tipo histológico más frecuente fue el carcinoma epidermoide (67,8 %). Conclusiones: Se demostró la importancia de la broncoscopia y sus procedimientos diagnósticos para confirmar la existencia del proceso morboso.
Introduction: It is denominated as lung cancer to a group of diseases resulting from the abnormal growth of cells of the breathing tract, in particular of the lung tissue. Objective: To determine the useful bronchoscopic and histologic aspects in the confirmation of the diagnosis of these neoplasms. Methods: A descriptive and cross-sectional investigation of the 346 patients assisted due to lung cancer in the Pulmonology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba during 2016 and 2017 to whom a bronchoscopy was carried out. The variables used were age, sex, diagnostic technique used, histopatologic diagnosis and more frequent localization. Results: The patients aged 56 and 75 (66.1 %), as well as the male sex (65.0 %) prevailed. The bronchial biopsy was the procedure that mostly revealed the presence of cancer (61.3 %) and the most frequent histologic type was the squamous cell carcinoma (67.8 %). Conclusions: The importance of bronchoscopy and its diagnostic procedures to confirm the existence of the morbid process was demonstrated.