RESUMO
INTRODUCTION: The goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors. OBJECTIVE: To highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy. CONCLUSION: The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen.
Assuntos
Neoplasias Laríngeas/patologia , Laringectomia/métodos , Laringe/patologia , Patologia Clínica/métodos , Humanos , Comunicação Interdisciplinar , Neoplasias Laríngeas/cirurgia , Oncologia , Gradação de Tumores , Invasividade Neoplásica , Tratamentos com Preservação do Órgão , Otolaringologia , Equipe de Assistência ao Paciente , Seleção de Pacientes , Manejo de Espécimes , Prega VocalRESUMO
The purpose of conservative surgical treatment of laryngeal cancer is to obtain cancer control with preservation of laryngeal function, and in turn, the preservation of laryngeal function should be understood as the preservation of the patient's ability to ventilate in the normal way without tracheostomy and without aspiration and maintaining intelligible speech. This objective is achieved by maintaining a balance between two fundamental aspects: proper patient selection (based on tumor extension and preoperative laryngeal function) and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy (SCSL) is the voice conservative surgical technique which offers the best possibility of control in patients with locally advanced laryngeal cancer, and the proper histopathological analysis allows staging and selecting patients eligible for adjuvant therapy, avoiding unnecessary therapies, and allows design of a monitoring and surveillance program based on risk factors. The aim of this manuscript is to highlight key points in the histopathological evaluation of the surgical specimen of SCSL. The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumor leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathologic evaluation of the surgical specimen.
Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Seleção de Pacientes , Humanos , Neoplasias Laríngeas/patologia , Estadiamento de Neoplasias , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: the clear cell adenocarcinoma (CCA) in cervix is a rare disease. It represents only 2 to 7 % of whole adecocarcinomas of cervix. Its histological pattern seems identical to their counterparts elsewhere in the female genital tract, including the vagina, endometrial and ovary. The CCA is constituted by cells with a clear cytoplasm in tack that are arranged in a solid pattern, tubu-locystic, papillary, or mixed. CLINICAL CASE: an eleven year old girl with sporadic and intermittent transvaginal bleeding, and who felt in severe anemia due to hiperpolimenorrea treated with athinyl estradiol deso-gestrel was attended. She had not history of exposition in utero to diethyletilbestrol. Hysteroscopy showed an ectocervical exophytic lesion in a barrel of 7 × 3 × 3 cm, located predominantly in the posterior lip. A frozen section of the lesion was reported as a poorly differentiated malignant tumor compatible with cervical carcinoma. She underwent to simple trachelectomy. CONCLUSIONS: diagnostic difficulty was the age of the patient and the lack exposition in utero to DES, the differential diagnosis included the age group tumors and rhabdomyosarcoma botryoides and extragonadal endodermic origen with papillary and reticular pattern. Another was a metastatic CCA.