RESUMO
INTRODUCTION: Adenoid cystic carcinoma (ACC) is a rare tumor, with an annual incidence of 3-4.5 cases/million. MATERIALS AND METHODS: We conducted a descriptive and retrospective study. We included patients diagnosed with ACC of head and neck of a single third-level referral center, from January 2008 to December 2013. RESULTS: A total of 23 patients were included in the study, 10 males (43.5%) and 13 females (56.5%) (F:M ratio 1.3:1). Median age was 52 years. Localization was predominantly observed in the oral cavity (26%) followed by the palate (17.4%). At presentation, 15 patients (65.2%) had clinical Stage II. The most frequent histology was the cribriform type in 10 patients (43.5%). Following resection, positive margins were observed in 15 (65.2%), neural invasion in 8 (34.8%), and lymphovascular invasion in 2 (8.7%) patients. The median time to recurrence in our population was 23 months. Recurrence at 5 years was observed in 15 patients (65%). At 2 years, recurrence was predominantly local in 7 patients (46%); whereas after 2 years, it was predominantly pulmonary 6 patients (40%). Overall, 5 year-survival was 78%. CONCLUSIONS: Cystic adenoid carcinoma is characterized by a high recurrence rate. Nevertheless, it has a high overall 5-year survival, which justifies an aggressive treatment.
ANTECEDENTES: El carcinoma adenoide quístico es un tumor raro, con una incidencia anual de 3-4.5 casos por millón. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo, que incluyó pacientes con carcinoma adenoide quístico de cabeza y cuello de un centro de referencia de tercer nivel, desde enero de 2008 hasta diciembre de 2013. RESULTADOS: Se incluyeron 23 pacientes, 10 hombres (43.5%) y 13 mujeres (56.5%) (relación 1.3:1), con una media de edad de 52 años. Predominó en la cavidad bucal (26%), seguida del paladar (17.4%). Al diagnóstico, 15 pacientes (65.2%) tenían estadio clínico II. La histología cribiforme fue la más frecuente (10 pacientes; 43.5%). Posterior a la cirugía, se observaron márgenes positivos en 15 (65.2%), invasión neural en 8 (34.8%) e invasión linfovascular en 2 (8.7%) pacientes. La media de recurrencia fue de 23 meses. La recurrencia a 5 años se observó en 15 pacientes (65%). A los 2 años predominó la recurrencia local (7 pacientes; 46%); después de los 2 años predominaron las metástasis pulmonares (6 pacientes; 40%). La supervivencia a 5 años fue del 78%. CONCLUSIONES: El carcinoma adenoide quístico se caracteriza por una alta tasa de recurrencia. Sin embargo, tiene una alta supervivencia global a 5 años, lo que justifica un tratamiento agresivo.
Assuntos
Carcinoma Adenoide Cístico/patologia , Neoplasias de Cabeça e Pescoço/patologia , Adulto , Carcinoma Adenoide Cístico/terapia , Quimioterapia Adjuvante , Feminino , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Neoplasias do Seio Maxilar/patologia , Neoplasias do Seio Maxilar/terapia , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/terapia , Terapia Neoadjuvante , Invasividade Neoplásica , Neoplasias Palatinas/patologia , Neoplasias Palatinas/terapia , Radioterapia Adjuvante , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de TempoAssuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias do Seio Maxilar/terapia , Hemangioma/terapia , Biópsia , Neoplasias do Seio Maxilar/diagnóstico , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Terapia Combinada , Embolização Terapêutica , Hemangioma/diagnósticoAssuntos
Hemangioma/terapia , Neoplasias do Seio Maxilar/terapia , Adulto , Biópsia , Terapia Combinada , Embolização Terapêutica , Feminino , Hemangioma/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias do Seio Maxilar/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
This paper describes the surgical correction of ankylosis of the right temporomandibular joint and reconstruction of the middle and lower thirds of the right side of the face in a young man who had undergone treatment for hemangiopericytoma 10 years earlier, which led to serious functional, esthetic, and psychological problems and diminished his quality of life. The results of reconstruction surgery with alloplastic material (Medopor®) and surgical planning with fibrotic tissue due to radiation and the risk of osteoradionecrosis are discussed.
Assuntos
Assimetria Facial/cirurgia , Hemangiopericitoma/terapia , Neoplasias do Seio Maxilar/terapia , Procedimentos de Cirurgia Plástica , Quimiorradioterapia Adjuvante , Criança , Terapia Combinada/métodos , Humanos , Masculino , Adulto JovemAssuntos
Neoplasias Ósseas/patologia , Neoplasias do Seio Maxilar/patologia , Osteossarcoma/patologia , Osteossarcoma/secundário , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/secundário , Adulto , Biópsia por Agulha Fina , Neoplasias Ósseas/terapia , Endossonografia , Humanos , Metástase Linfática , Masculino , Neoplasias do Seio Maxilar/terapia , Osteossarcoma/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Ultrassonografia de IntervençãoRESUMO
CONTEXT: Malignant neural sheath tumors of the trigeminal nerve affecting the nasal cavity and the paranasal sinuses are extremely rare. With conventional optical microscopy, their identification is difficult, and it is necessary to confirm them by means of electron microscopy and immunohistochemical techniques. CASE REPORT: The patient was a 41-year-old woman with a ten-month progressive history of pain followed by painful edema in the left facial region, and with symptoms of bleeding, secretion and nasal obstruction. Studies with imaging methods suggested the presence of an expansive process in the left nasal and paranasal cavities. In the biopsy, the histopathological findings from optical microscopy were suggestive of a tumor of neural origin in the trigeminal nerve. Immunohistochemical and electron microscopy studies confirmed that it was a malignant tumor of the neural sheath of the trigeminal nerve. We describe the clinical, radiological, and histological features of this tumor and review the literature.
CONTEXTO: O tumor maligno da bainha neural do trigêmeo que acomete a cavidade nasal e os seios paranasais é extremamente raro. A microscopia óptica habitual sua identificação é difícil, sendo necessária a confirmação através de microscopia eletrônica e de técnicas imunoistoquímicas. RELATO DE CASO: A paciente era uma mulher de 41 anos com história de 10 meses de progressiva dor seguida de edema álgico em região facial à esquerda, e de sintomas de sangramento, secreção e obstrução nasal. Estudos com métodos de imagem sugeriam a presença de processo expansivo em cavidades nasais e paranasais à esquerda. A biopsia, os achados histopatológicos à microscopia óptica foram sugestivos de tumor de origem neural no trigêmeo. Estudos imunoistoquímico e por microscopia eletrônica confirmaram se tratar de neoplasia maligna da bainha neural do trigêmeo. Descrevemos as características clínicas, radiológicas e histológicas deste tumor, e revisamos a literatura.
Assuntos
Humanos , Feminino , Adulto , Neoplasias do Seio Maxilar/ultraestrutura , Neoplasias de Bainha Neural/ultraestrutura , Sarcoma/ultraestrutura , Nervo Trigêmeo/ultraestrutura , Biópsia , Imuno-Histoquímica , Neoplasias do Seio Maxilar/terapia , Microscopia Eletrônica , Neoplasias de Bainha Neural/terapia , Sarcoma/terapia , Tomografia Computadorizada por Raios XRESUMO
CONTEXT: Malignant neural sheath tumors of the trigeminal nerve affecting the nasal cavity and the paranasal sinuses are extremely rare. With conventional optical microscopy, their identification is difficult, and it is necessary to confirm them by means of electron microscopy and immunohistochemical techniques. CASE REPORT: The patient was a 41-year-old woman with a ten-month progressive history of pain followed by painful edema in the left facial region, and with symptoms of bleeding, secretion and nasal obstruction. Studies with imaging methods suggested the presence of an expansive process in the left nasal and paranasal cavities. In the biopsy, the histopathological findings from optical microscopy were suggestive of a tumor of neural origin in the trigeminal nerve. Immunohistochemical and electron microscopy studies confirmed that it was a malignant tumor of the neural sheath of the trigeminal nerve. We describe the clinical, radiological, and histological features of this tumor and review the literature.
Assuntos
Neoplasias do Seio Maxilar/patologia , Neoplasias de Bainha Neural/patologia , Sarcoma/patologia , Nervo Trigêmeo/patologia , Adulto , Biópsia , Feminino , Humanos , Imuno-Histoquímica , Neoplasias do Seio Maxilar/terapia , Neoplasias do Seio Maxilar/ultraestrutura , Microscopia Eletrônica , Neoplasias de Bainha Neural/terapia , Neoplasias de Bainha Neural/ultraestrutura , Sarcoma/terapia , Sarcoma/ultraestrutura , Tomografia Computadorizada por Raios X , Nervo Trigêmeo/ultraestruturaRESUMO
AIMS: The aim of the present study is to define prognostic factors, particularly the impact of treatment on paranasal sinus and nasal cavity malignancies. MATERIAL AND METHODS: Retrospective study of patients with maxillary antrum and nasal fossae malignancies. A maxillectomy classification as performed to treat malignancies in our institution is described. Multivariate analysis of prognostic factors was done using the Cox's model. RESULTS: One hundred and nine patients were evaluated. Squamous cell carcinoma was found in 62 cases and in 95 patients the epicentre of the tumour was located in the maxillary antrum. Ten patients were treated with surgery only, 39 patients with surgery and adjuvant radiation therapy, 37 cases received only radiotherapy, and 18 received radiotherapy followed by surgery; in five cases a combination of chemo-radiotherapy was used. Multivariate analysis identified T classification, orbit invasion, N classification, site of origin of tumour in nasal fossae, and no surgical resection as independent prognostic factors (p=0.0001). CONCLUSION: T4 tumours with orbit invasion present bad prognosis as compared to other T4 tumours. Surgical resection should be included in the treatment strategy. Because of the high frequency of lymph-node metastasis, neck treatment should be considered in T4 tumours.
Assuntos
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Neoplasias do Seio Maxilar/terapia , Neoplasias Nasais/terapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Humanos , Maxila/cirurgia , Neoplasias do Seio Maxilar/mortalidade , Neoplasias do Seio Maxilar/patologia , Pessoa de Meia-Idade , Cavidade Nasal , Estadiamento de Neoplasias , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Prognóstico , Radioterapia , Estudos Retrospectivos , Análise de SobrevidaRESUMO
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