RESUMEN
El hiperparatiroidismo primario (HPTP) es poco frecuente en niños y adolescentes. Hay escasos datos para el manejo de estos pacientes en pediatría. Las glándulas paratiroideas son glándulas endocrinas que secretan hormona paratiroidea (PTH) y regulan el metabolismo del calcio y del fósforo. La sobreexpresión de PTH se llama hiperparatiroidismo, que se clasifica en primario, secundario y terciario. En los adolescentes, 80 a 92% de los hiperparatiroidismos primarios se deben a adenoma paratiroideo. Presentamos el caso clínico de una adolescente con una primera manifestación atípica de HPTP, la presencia de un tumor pardo del paladar, presentación rara de adenoma paratiroideo, acompañado de hipercalcemia, marcada elevación de PTH y varias lesiones óseas. (AU)
Primary hyperparathyroidism (PHPT) in children and adolescents is uncommon. Guidelines for management in pediatric patients are limited. Parathyroid glands are endocrine glands that secrete parathyroid hormone (PTH) and regulate calciumphosphate metabolism. The overexpression of PTH is called hyperparathyroidism, and is classified as primary, secondary, and tertiary. In adolescents, 80 to 92% of PHPT cases are due to a parathyroid adenoma. We present here a case report of an adolescent with a brown tumor of the palate as the first manifestation of the disease, atypical and rare presentation of parathyroid adenoma in an adolescent. She had hypercalcemia, marked elevation of PTH and bone lesions. (AU)
Asunto(s)
Humanos , Femenino , Niño , Neoplasias de las Paratiroides/diagnóstico , Neoplasias Palatinas/etiología , Adenoma/diagnóstico , Hiperparatiroidismo Primario/complicaciones , Neoplasias de las Paratiroides/cirugía , Neoplasias Palatinas/diagnóstico por imagen , Adenoma/cirugía , Hiperparatiroidismo Primario/etiologíaRESUMEN
Pleomorphic Adenoma (PA) is the most common benign salivary gland tumor. The most common sites for minor salivary gland from which PA arises are the palate followed by the lips and buccal mucosa. Calcifications are a common finding in major salivary glands with chronic inflammatory disorders. Major salivary gland tumors rarely show calcifications and it is less common to find them in minor salivary gland tumors. We report a case of pleomorphic adenoma of the hard palate in a 67-year-old female patient with intra-tumoral, irregular and scattered calcifications visible on computed tomography (CT). The treatment was complete surgical excision of the lesion. The diagnosis was confirmed with the histopathological study.
El adenoma pleomórfico (AP) es el tumor benigno de las glándulas salivales más común. Los sitios de mayor frecuencia donde surge el AP en glándulas salivales menores es el paladar seguido de los labios y la mucosa bucal. Las calcificaciones son un hallazgo común en las glándulas salivales mayores con trastornos inflamatorios crónicos, pero en el caso de tumores rara vez muestran calcificaciones y es menos común encontrarlos en tumores de las glándulas salivales menores. Presentamos un caso de adenoma pleomórfico del paladar duro en una paciente de 67 años con calcificaciones intratumorales, irregulares y dispersas visibles en la tomografía computarizada. El tratamiento fue la extirpación quirúrgica completa de la lesión. El diagnóstico se confirmó con el estudio histopatológico
Asunto(s)
Humanos , Femenino , Anciano , Enfermedades de las Glándulas Salivales/cirugía , Neoplasias Palatinas/cirugía , Adenoma Pleomórfico/cirugía , Glándulas Salivales Menores , Biopsia , Neoplasias de las Glándulas Salivales , Neoplasias Palatinas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenoma Pleomórfico/diagnóstico por imagen , Paladar DuroRESUMEN
No disponible
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Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Palatinas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Úvula , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodosRESUMEN
BACKGROUND: When amenable to radical excision, cancer involving the maxilla is typically treated with maxillectomy followed by adjuvant therapy. Posterior tumor extension beyond the maxillary box leads to the invasion of complex areas, where achieving clear margins may be challenging. METHODS: Patients undergoing endoscopic-assisted maxillectomy for nasoethmoidal, maxillary, or hard palate cancer between 2007 and 2017 were included in the study. Surgical technique, margin status, and recurrences were analyzed. Extension of posterior resection was classified in 3 types (type 1: resection of the pterygopalatine fossa; type 2: resection of the pterygoid plates and related muscles; type 3: resection of the upper parapharyngeal space). The analysis of putative risk factors for involvement of margins and local recurrence was performed with special focus on the posterior and medial margin. RESULTS: The study included 79 patients (75 with available follow-up; mean: 20.6â¯months, range: 6-101â¯months), 37 (46.8%) of whom underwent type 1 resection, 34 (43.0%) type 2, and 8 (10.1%) type 3. According to pT category, 57 (72.2%) tumors were classified as T4a/T4b. Posterior and medial clear margins were achieved in 76/79 (96.2%) and 75/79 (94.9%) patients, respectively. T4b category, extension to the ethmoid, sphenoid sinus, pterygoid process, orbital cavity, and premaxillary tissues were significantly associated with a higher rate of margin involvement. None of the factors was significantly associated with medial margin involvement. CONCLUSION: Endoscopic-assisted maxillectomy combines several refinements including the facilitated detachment of the maxilla from the skull base and precise delineation of the posterior and medial margins of resection.
Asunto(s)
Neoplasias Maxilares/cirugía , Neoplasias Nasales/cirugía , Neoplasias Palatinas/cirugía , Neoplasias de los Senos Paranasales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Márgenes de Escisión , Neoplasias Maxilares/diagnóstico por imagen , Neoplasias Maxilares/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasias Nasales/diagnóstico por imagen , Neoplasias Nasales/patología , Neoplasias Palatinas/diagnóstico por imagen , Neoplasias Palatinas/patología , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Neoplasias de los Senos Paranasales/patología , Pronóstico , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/métodos , Adulto JovenRESUMEN
Objetivo: relatar uma biópsia excisional de um osteoma periférico no palato duro direito de uma paciente jovem, do sexo feminino e não sindrômica. Relato de caso: paciente do sexo feminino, 32 anos de idade, melanoderma e normossitêmico, buscou atendimento no ambulatório de diagnóstico estomatológico da Faculdade de Odontologia da Universidade Federal de Uberlândia com queixa quanto ao surgimento de lesão na região de palato. Após avaliação clínica e imaginológica, foi decidido realizar biópsia excisional sob anestesia local da lesão. Foram levantadas três hipóteses de diagnóstico: osteoma periférico, exostose ou osteossarcoma. O material coletado foi enviado para análise histopatológica, que confirmou a hipótese de osteoma periférico. Considerações finais: os osteomas periféricos na região de palato duro são raríssimos. Essa lesão geralmente é assintomática exceto quando há impacto traumático durante a mastigação , de crescimento lento, podendo se desenvolver em osso cortical ou medular. O tratamento de escolha é a remoção cirúrgica e o índice de recorrência é raro. O caso enfatiza a condição rara, pois foram encontrados apenas seis casos semelhantes relacionados na literatura. (AU)
Objective: To report an excisional biopsy of a peripheral osteoma in the right hard palate in a non-syndromic young female patient. Case Report: A 32-year-old female patient, black, and normosystemic sought assistance in the stomatological diagnosis outpatient clinic of the School of Dentistry of the Federal University of Uberlândia, Brazil, complaining about the appearance of a lesion in the palate region. After clinical and imaging assessment, it was decided to perform an excisional biopsy under local anesthesia of the lesion. Three diagnostic hypotheses were raised - peripheral osteoma, exostosis, or osteosarcoma. The material collected was sent for histopathological analysis, which confirmed the hypothesis of peripheral osteoma. Final considerations: Peripheral osteomas in the hard palate region are very rare. This lesion is usually asymptomatic, except when there is a slow-growing chewing impact during mastication, which may develop in cortical or spinal bone. Surgical removal is the treatment of choice and the rate of recurrence is rare. The case emphasizes the rare condition, considering only six similar cases were found in the literature. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Osteoma/patología , Neoplasias Palatinas/patología , Paladar Duro/patología , Osteoma/cirugía , Osteoma/diagnóstico por imagen , Biopsia , Radiografía Dental , Neoplasias Palatinas/cirugía , Neoplasias Palatinas/diagnóstico por imagen , Enfermedades RarasRESUMEN
BACKGROUND: To evaluate the computed tomographic features and create a prediction model for clinical diagnosis of adenoid cystic carcinoma (ACC) in the palate with intact mucosa. METHODS: From March 2016 to May 2018, 102 patients with palatal tumors and intact mucosa, including 28 patients with a pathological diagnosis of ACC after surgery, were enrolled in this study. The patients' clinical symptoms, computed tomographic features and pathological diagnoses were recorded and analyzed. Independent predictors of ACC were determined by using univariate analysis and multivariate logistic regression, and the discrimination and calibration of the prediction model was evaluated, and internal validation was performed. RESULTS: Univariate analysis of patients showed that ACC patients were more likely than non-ACC patients to be older (P = 0.019); to have palatine bone destruction (P<0.001) and greater palatine foramen (GPF) enlargement (P<0.001); to have involvement of the pterygopalatine fossa (P<0.001), foramen rotundum (P<0.001), nasal cavity (P<0.001) and maxillary bone (P<0.001); and to have numbness (P = 0.007) and pain (P<0.001). Multivariate logistic analysis showed that age and GPF enlargement were independent predictors of ACC in palatal tumors. The diagnostic prediction model showed good discrimination and calibration, as evaluated by the area under the receiver operating characteristic curve (0.98) and the Hosmer-Lemeshow goodness-of-fit test (P = 0.927). CONCLUSIONS: The palate ACC prediction model based on age and GPF enlargement shows excellent discrimination with no evidence of poor calibration. Older patients with palatal tumors and intact mucosa should be considered for ACC when they have GPF enlargement.
Asunto(s)
Carcinoma Adenoide Quístico/diagnóstico por imagen , Neoplasias Palatinas/diagnóstico por imagen , Hueso Paladar/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/diagnóstico por imagen , Paladar Duro , Tomografía Computarizada por Rayos XAsunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Palatinas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Úvula , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodosRESUMEN
Hemangiomas are the most common tumors of childhood with an average incidence of 10%. It is unusual for hemangiomas, which are already rarely seen isolated on the palate, to coexist with cleft palate as in the authors' patient. Four months old baby was admitted with isolated Veau 2 cleft palate and a red-purple colored raised lesion involving almost the whole right side of the hard palate. Magnetic resonance imaging revealed intensive contrasting solid nodule with a lobulated contour that was covering the right half of the hard palate, measuring 2.2×1.3âcm. To reduce the size of the vascular lesion 7âmg/d oral propranolol treatment was initiated. Following reduction in the size of hemangioma, the cleft palate was repaired at 11 months of age. Single mucoperiosteal flap from the left side of the palate preserving the major palatine artery was elevated whereas right mucoperisteal flap was minimally dissected not to interfere with the hemangioma. No intraoperative and postoperative complications in both the early and late term were experienced. As a result, since early palatal repair is important to obtain ideal speech outcomes in cleft patients, repair should be performed in similar patients with hemangiomas without delaying the timing.
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Fisura del Paladar/cirugía , Hemangioma/cirugía , Neoplasias Palatinas/cirugía , Colgajos Quirúrgicos/trasplante , Fisura del Paladar/diagnóstico por imagen , Comorbilidad , Femenino , Estudios de Seguimiento , Hemangioma/diagnóstico por imagen , Humanos , Lactante , Neoplasias Palatinas/diagnóstico por imagen , Paladar Duro/diagnóstico por imagen , Paladar Duro/cirugía , Cuidados Preoperatorios , Propranolol/administración & dosificación , Técnicas de SuturaAsunto(s)
Neoplasias Palatinas/diagnóstico por imagen , Neoplasias Palatinas/cirugía , Anciano de 80 o más Años , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Disección del Cuello , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG) is a recently described entity, with most cases previously published as polymorphous low-grade adenocarcinoma (PLGA). Typical cases share some main characteristics, such as oral sites (mainly tongue), regional lymph node metastasis, and morphology resembling solid and follicular variants of papillary thyroid carcinoma. OBJECTIVE: To present a CATMSG and emphasize the importance of reclassifying PLGAs with unusual behavior. CASE REPORT: A 78-year-old male presented with an ulcerated mass in the soft palate treated as PLGA. The patient developed 5 regional metastases over 11 years of follow-up, all diagnosed as PLGA. He died due to the disease, and because of the very aggressive behavior of PLGA, all histopathologic slides were revised and the tumor was reclassified as CATMSG. CONCLUSION: This report emphasizes the importance of reevaluating aggressive PLGA and contributes to a better understanding of CATMSG.
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Adenocarcinoma/patología , Metástasis Linfática/patología , Neoplasias Palatinas/secundario , Neoplasias de las Glándulas Salivales/patología , Glándulas Salivales Menores/patología , Neoplasias de la Lengua/patología , Adenocarcinoma/diagnóstico por imagen , Anciano , Biopsia , Diagnóstico Diferencial , Resultado Fatal , Humanos , Masculino , Neoplasias Palatinas/diagnóstico por imagen , Paladar Blando , Radiografía Panorámica , Neoplasias de las Glándulas Salivales/diagnóstico por imagen , Glándulas Salivales Menores/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Neoplasias de la Lengua/diagnóstico por imagenRESUMEN
Palatal tumours are relatively rare and of variable aetiology, rendering radiological evaluation a daunting process for many. A systematic approach to the imaging of a palatal lump is therefore essential. The hard and soft palates are oral cavity and oropharyngeal structures, respectively. They have different tissue compositions, and therefore, lesions occur with different frequencies at each site. The hard palate has the highest concentration of minor salivary glands in the upper aerodigestive tract and most tumours here are salivary in origin, whereas most tumours at the soft palate are epithelial in origin, i.e., squamous cell carcinomas, in line with other oropharyngeal subsites. The most common malignant tumours of the palate, after squamous cell carcinoma, are minor salivary gland tumours, predominantly adenoid cystic and mucoepidermoid carcinomas. These tumours have a propensity to spread perineurally; understanding the anatomy and imaging features of perineural spread is vital, as it can have significant implications for patient management and tumour resectability. When confronted with a palatal lump, it is important to consider the following: its location on the hard or soft palate; whether it is mucosal or submucosal; the frequently occurring lesions at that site; the most suitable imaging techniques (ultrasound, computed tomography, magnetic resonance imaging); whether there are typical imaging features for any of the common lesions; and whether there are aggressive features, such as bone erosion or perineural spread. This approach allows the radiologist to narrow the differential diagnosis and assist the clinicians with planning treatment.
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Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Neoplasias Palatinas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Diagnóstico Diferencial , HumanosRESUMEN
We present a case of sclerosing odontogenic carcinoma (SOC) occurring on the hard palate of a 43-year-old female. The tumor presented as an asymptomatic firm swelling and histopathologically was characterized by widely dispersed nests and cords of bland cells infiltrating between hyalinized collagen fibers. Prominent perineural and intraneural invasion and erosion of bone was noted. The tumor cells showed staining with antibodies to pan-cytokeratin (PanCK), cytokeratin 19 (CK19), cytokeratin 5/6 (CK5/6), cytokeratin 14 (CK14), p63 and E-cadherin, but no staining with antibodies to carcinoembryonic antigen (CEA), cytokeratin 7 (CK7), cytokeratin 20 (CK20), estrogen receptor (ER), progesterone receptor (PR) or S100. Staining for mucin with alcian blue/periodic acid-Schiff with diastase was equivocal, with no definite evidence of mucin or muciphages. An initial diagnosis of adenocarcinoma NOS was made upon incisional biopsy, with the prominent filing pattern and cytoplasmic vacuolization prompting consideration of metastatic breast cancer in the first instance. The true nature of the tumor became clear after staging investigations and surgical resection. The patient was treated by surgery alone and is disease-free after 17 months.
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Tumores Odontogénicos/diagnóstico , Neoplasias Palatinas/diagnóstico , Paladar Duro/patología , Adulto , Biomarcadores de Tumor/análisis , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Estadificación de Neoplasias , Tumores Odontogénicos/diagnóstico por imagen , Tumores Odontogénicos/patología , Tumores Odontogénicos/cirugía , Neoplasias Palatinas/diagnóstico por imagen , Neoplasias Palatinas/patología , Neoplasias Palatinas/cirugía , Paladar Duro/diagnóstico por imagen , Radiografía Panorámica , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Non-Hodgkin lymphomas (NHL) in the palate are very rare. We aimed to investigate the CT appearance of lymphoma in the palate to improve diagnostic quality and review the literature on NHL. MATERIALS AND METHODS: The study retrospectively included patients with histopathologically confirmed lymphoma who were treated at our hospital between 2008 and 2015. We examined CT features, including tumor location, appearance, margins, and involvement of the surrounding tissues. RESULTS: Records were available for eight cases of lymphoma over the study period. Of these, two were in the soft palate and six in the hard palate. Median age at presentation was 63 years. Seven of the eight were diffuse large B cell lymphoma and one was T cell lymphoma. Hard palate lymphoma on CT showed bone destruction and spread to the maxillary arch and maxillary sinuses, whereas soft palate lymphoma spread to the surrounding parapharyngeal area and did not show bone destruction. CONCLUSION: We describe CT findings of palate lymphoma, which are important for treatment planning.
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Linfoma no Hodgkin/diagnóstico por imagen , Neoplasias Palatinas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Neoplasias Palatinas/patología , Estudios RetrospectivosAsunto(s)
Quistes/diagnóstico por imagen , Imagen por Resonancia Magnética , Neurilemoma/diagnóstico por imagen , Neoplasias Palatinas/diagnóstico por imagen , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Adulto , Quistes/patología , Quistes/cirugía , Femenino , Humanos , Angiografía por Resonancia Magnética , Márgenes de Escisión , Invasividad Neoplásica , Neurilemoma/irrigación sanguínea , Neurilemoma/patología , Neurilemoma/cirugía , Neoplasias Palatinas/irrigación sanguínea , Neoplasias Palatinas/patología , Neoplasias Palatinas/cirugía , Neoplasias de la Base del Cráneo/irrigación sanguínea , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/cirugíaAsunto(s)
Fibroma/patología , Neoplasias Palatinas/patología , Paladar Duro/patología , Adulto , Edema/etiología , Femenino , Fibroma/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Dolor/etiología , Neoplasias Palatinas/diagnóstico por imagen , Paladar Duro/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
This paper is a clinicopathologic correlation regarding a 61-year-old patient with an ill-fitting maxillary denture. Examination revealed a firm, nontender palatal mass. Descriptions of the clinical findings, work-up, differential diagnosis, histological observations, and diagnosis of the lesion are presented.
Asunto(s)
Adenocarcinoma/diagnóstico , Dentaduras , Neoplasias Palatinas/diagnóstico , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Tomografía Computarizada de Haz Cónico , Dentaduras/efectos adversos , Diagnóstico Diferencial , Humanos , Masculino , Maxilar , Persona de Mediana Edad , Neoplasias Palatinas/diagnóstico por imagen , Neoplasias Palatinas/patología , Hueso Paladar/diagnóstico por imagen , Hueso Paladar/patologíaRESUMEN
OBJECTIVE: This paper reports the case of a 13-year-old girl with a 2-year history of left cervical lymph node swelling that was diagnosed as metastatic cribriform adenocarcinoma of the tongue and minor salivary gland. CASE REPORT: A 13-year-old girl with a left, level II cervical lymph node underwent excisional biopsy after an ultrasound suggested suspicious features. The histology indicated polymorphous low-grade adenocarcinoma, and a primary lesion in the left palate was identified. The patient underwent left maxillectomy, neck dissection and reconstruction. Histological analysis of resection specimens led to a revised diagnosis of cribriform adenocarcinoma of the tongue and minor salivary gland. CONCLUSION: Cribriform adenocarcinoma of the tongue and minor salivary gland has recently been described as a separate entity to polymorphous low-grade adenocarcinoma in light of histological and behavioural differences, including higher rates of metastasis at presentation. This is the first report in the world literature of an adolescent with this entity. It is possible that some previous reports of polymorphous low-grade adenocarcinoma in childhood would have been more accurately described as cribriform adenocarcinoma of the tongue and minor salivary gland.
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Adenocarcinoma/patología , Ganglios Linfáticos/patología , Neoplasias Palatinas/patología , Neoplasias de las Glándulas Salivales/patología , Glándulas Salivales Menores/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Adolescente , Femenino , Humanos , Ganglios Linfáticos/cirugía , Metástasis Linfática , Neoplasias Palatinas/diagnóstico por imagen , Neoplasias Palatinas/cirugía , Neoplasias de las Glándulas Salivales/diagnóstico por imagen , Neoplasias de las Glándulas Salivales/cirugía , Glándulas Salivales Menores/diagnóstico por imagen , Glándulas Salivales Menores/cirugía , Neoplasias de la Lengua/diagnóstico por imagen , Neoplasias de la Lengua/patología , Neoplasias de la Lengua/cirugía , UltrasonografíaAsunto(s)
Adenoma Pleomórfico/diagnóstico por imagen , Neoplasias Palatinas/diagnóstico por imagen , Paladar Blando , Adenoma Pleomórfico/patología , Anciano de 80 o más Años , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Palatinas/patología , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Setup, range, and anatomical uncertainties influence the dose delivered with intensity modulated proton therapy (IMPT), but clinical quantification of these errors for oropharyngeal cancer is lacking. We quantified these factors and investigated treatment fidelity, that is, robustness, as influenced by adaptive planning and by applying more beam directions. METHODS AND MATERIALS: We used an in-house treatment planning system with multicriteria optimization of pencil beam energies, directions, and weights to create treatment plans for 3-, 5-, and 7-beam directions for 10 oropharyngeal cancer patients. The dose prescription was a simultaneously integrated boost scheme, prescribing 66 Gy to primary tumor and positive neck levels (clinical target volume-66 Gy; CTV-66 Gy) and 54 Gy to elective neck levels (CTV-54 Gy). Doses were recalculated in 3700 simulations of setup, range, and anatomical uncertainties. Repeat computed tomography (CT) scans were used to evaluate an adaptive planning strategy using nonrigid registration for dose accumulation. RESULTS: For the recalculated 3-beam plans including all treatment uncertainty sources, only 69% (CTV-66 Gy) and 88% (CTV-54 Gy) of the simulations had a dose received by 98% of the target volume (D98%) >95% of the prescription dose. Doses to organs at risk (OARs) showed considerable spread around planned values. Causes for major deviations were mixed. Adaptive planning based on repeat imaging positively affected dose delivery accuracy: in the presence of the other errors, percentages of treatments with D98% >95% increased to 96% (CTV-66 Gy) and 100% (CTV-54 Gy). Plans with more beam directions were not more robust. CONCLUSIONS: For oropharyngeal cancer patients, treatment uncertainties can result in significant differences between planned and delivered IMPT doses. Given the mixed causes for major deviations, we advise repeat diagnostic CT scans during treatment, recalculation of the dose, and if required, adaptive planning to improve adequate IMPT dose delivery.
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Órganos en Riesgo/efectos de la radiación , Neoplasias Orofaríngeas/radioterapia , Terapia de Protones/métodos , Planificación de la Radioterapia Asistida por Computador/métodos , Errores de Configuración en Radioterapia/efectos adversos , Radioterapia de Intensidad Modulada/métodos , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Órganos en Riesgo/anatomía & histología , Órganos en Riesgo/diagnóstico por imagen , Neoplasias Orofaríngeas/diagnóstico por imagen , Neoplasias Orofaríngeas/patología , Neoplasias Palatinas/diagnóstico por imagen , Neoplasias Palatinas/patología , Neoplasias Palatinas/radioterapia , Paladar Blando , Mejoramiento de la Calidad , Radiografía , Neoplasias de la Lengua/diagnóstico por imagen , Neoplasias de la Lengua/patología , Neoplasias de la Lengua/radioterapia , Neoplasias Tonsilares/diagnóstico por imagen , Neoplasias Tonsilares/patología , Neoplasias Tonsilares/radioterapia , IncertidumbreRESUMEN
BACKGROUND: Intraoral inflammatory pseudotumor (IPT) is a rare, benign non-neoplastic lesion that presents as a rapidly growing mass with aggressive behavior, which can be mistaken for a malignant process. CASE REPORT: This article presents a rare case of IPT of the mandible in a 70-year-old male patient. Examination of the oral cavity revealed a hemorrhagic soft mass of the mandibular region. The patient was treated with surgery. Histologic examination of the resected specimen showed proliferation of fascicular spindle cells and a dense, chronic inflammatory cell infiltrate consisting of neutrophils, eosinophils, and lymphocytes. Immunohistochemically, the spindle cells expressed vimentin, α smooth muscle actin, and CD68, indicating a diagnosis of IPT. DISCUSSION: IPT is an unusual benign pathology in the oral and maxillofacial area. Because of its aggressive clinical and radiological features, it can be mistaken for a malignancy. We suggest that oral and maxillofacial surgeons should be aware of the specific features of IPT to avoid unnecessary aggressive treatments such as a radical resection.