Risk factors for jaw osteoradionecrosis: a case control study

Abstract There are divergences among studies regarding features associated to increased risk of osteoradionecrosis (ORN). Our objective was to identify factors that predispose to the development of ORN of the jaw. This was a retrospective, hospital-based, case-control study involving patients with head and neck cancer who had been treated with ≥ 60 Gy external radiotherapy (RT) to the jaw. A total of 19 cases of ORN and 43 controls were included. The patients' demographic data, tumor type, staging, treatment and outcome information, and pre-treatment oral status were collected. Univariate analysis showed that the oral cavity/oropharynx sites were associated with 9.77-fold increased risk of ORN development compared to other sites (p = 0.005). Being an active smoker was associated with 3.95-fold increased risk of ORN development (p = 0.01). A tendency towards increased risk of ORN was observed particularly when tooth extraction occurred after RT (odds ratio (OR): 3.04; p = 0.08). Multivariable analysis showed that tumor site was the only significant risk factor (OR: 21.03, p = 0.01). The oral and oropharyngeal primary site is an important risk factor for ORN. Dental extraction, which did not occur in 28% of the sample, was not an essential event for ORN development.

Prognostic factors from squamous cell carcinoma of the hard palate, gingiva and upper alveolar ridge

Abstract: The purpose of this study was to evaluate the clinicodemographic characteristics and treatment protocol as prognostic factors in patients with oral squamous cell carcinoma (OSCC) of the hard palate, upper gingiva, and alveolar ridge (HPUGAR). This retrospective cohort study collected data of patients treated in two head and neck surgery departments in southern Brazil between 1999 and 2021. Information on clinicodemographic data, habits, site, size, clinical aspect, clinical staging, cervical metastasis, treatment, and survival was collected. Associations between independent variables and outcomes were assessed using Pearson's chi-square test and binary regression. Kaplan-Meier test was employed to compare the survival between the neck approaches. Forty-one patients were included; most were male (61%), with a mean age of 68.8 (± 13.9) years. The consumption of tobacco (p = 0.003) and alcohol (p = 0.02) was significantly higher in male than in female patients. The main clinical features observed in the study sample were lesions larger than 2 cm (48.7%), no cervical (90.2%), or distant metastasis (90.2%). Surgery alone was the main treatment approach (48.8%). The watch-and-wait strategy was adopted in 34 cases (83.0%), while elective neck dissection was applied in five (12.2%). Only two patients with cN0 disease (4.9%) presented with cervical metastasis at follow-up. Eight patients (12.2%) died of the disease. Clinicodemographic variables, habits, surgical margins, and histological subtype were not significantly associated with cervical metastasis or survival. Cervical metastasis (p = 0.004) was associated with poor survival. No difference was detected in survival between different neck approaches (p = 0.28). Cervical metastasis and local recurrence are negative prognostic factors for HPUGAR OSCC.

Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck / Fatores associados a margens cirúrgicas incompletas no carcinoma basocelular de cabeça e pescoço

Abstract Introduction: Cutaneous basal cell carcinoma recurrence is associated with inadequate surgical margins. The frequency of and the factors associated with compromised or inadequate surgical margins in head and neck basal cell carcinoma varies. Objective: The purpose of this study was to evaluate the clinical and pathological factors associated with inadequate surgical margins in head and neck basal cell carcinoma. Methods: We developed a cross-sectional study comprising all patients who had undergone resection of head and neck basal cell carcinoma from January 2017 to December 2019. Data on age, sex, head and neck topography, histopathological findings, and staging were retrieved and compared. Each tumor was considered an individual case. Compromised and close margins were termed ''inadequate'' or ''incomplete''. Variables that were significantly associated with the presence of incomplete margins were further assessed by logistic regression. Results: In total, 605 tumors from 389 patients were included. Overall, sixteen cases (2.6%) were classified as compromised, 52 (8.5%) as close, and 537 (88.7%) as free margins. Presence of scleroderma (p = 0.005), higher Clark level (p < 0.001), aggressive variants (p < 0.001), invasion beyond the adipose tissue (p < 0.001), higher T stage (p < 0.001), perineural invasion (p = 0.002), primary site (p = 0.04), multifocality (p = 0.01), and tumor diameter (p = 0.02) showed association with inadequate margins. After Logist regression, multifocality, Clark level and depth of invasion were found to be independent risk factors for inadequate margins. Conclusion: Gross clinical examination may be sufficient for determining low prevalence of inadequate surgical margins when treating head and neck basal cell carcinoma in highly experienced oncologic centers. Multifocality, Clark level and depth of invasion were found to be independent risk factors for incomplete margins.

Resumo Introdução: A recorrência do carcinoma basocelular (CBC) cutâneo está associada a margens cirúrgicas inadequadas. A frequência e os fatores associados a margens cirúrgicas comprometidas ou inadequadas no carcinoma basocelular de cabeça e pescoço variam. Objetivo: Avaliar os fatores clínicos e patológicos associados a margens cirúrgicas inadequadas no carcinoma basocelular de cabeça e pescoço. Método: Conduzimos um estudo transversal que abrangeu todos os pacientes submetidos à resseçcão de carcinoma basocelular de cabeça e pescoço de janeiro de 2017 a dezembro de 2019. Dados sobre idade, sexo, topografia na cabeça e pescoço, achados histopatológicos e estadiamento foram recuperados e comparados. Cada tumor foi considerado como um caso individual. As margens comprometidas e próximas foram denominadas ''inadequadas'' ou ''incompletas''. As variáveis que foram significantemente associadas à presença de margens incompletas foram avaliadas adicionalmente por regressão logística. Resultados: Foram incluídos 605 tumores de 389 pacientes. No geral, 16 casos (2,6%) foram classificados como comprometidos, 52 (8,5%) como próximos e 537 (88,7%) como margens livres. Presença de esclerodermia (p = 0,005), nível de Clark mais elevado (p < 0,001), variantes agressivas (p < 0,001), invasão além do tecido adiposo (p < 0,001), estágio T mais avançado (p < 0,001), invasão perineural (p = 0,002), sítio primário (p = 0,04), multifocalidade (p = 0,01) e diâmetro do tumor (p = 0,02) mostraram associação com margens inadequadas. Após a regressão logística, a multifocalidade, o nível de Clark e a profundidade de invasão foram considerados fatores de risco independentes para margens inadequadas. Conclusão: O exame clínico macroscópico pode ser suficiente para determinar baixa prevalência de margens cirúrgicas inadequadas no tratamento do carcinoma basocelular de cabeça e pescoço em centros oncológicos altamente experientes. Multifocalidade, nível de Clark e profundidade de invasão foram considerados fatores de risco independentes para margens incompletas.

Better outcome for parotid versus neck metastasis of head and neck cutaneous squamous cell carcinoma: a new report on reemerging data / Melhor desfecho para metástase da parótida vs. cervical de carcinoma espinocelular cutâneo de cabeça e pescoço: um novo informe sobre dados reemergentes

Abstract Introduction Regional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival, currently with no distinction between parotid and neck metastasis. Objective The purpose of this study was to evaluate the prognostic features among patients with head and neck cutaneous squamous cell carcinoma exhibiting regional metastasis. Methods A retrospective analysis of patients with cutaneous squamous cell carcinoma who underwent parotidectomy and/or neck dissection from 2011 to 2018 at a single institution tertiary center was performed. Patient demographics, clinical, surgical and pathological information, adjuvant treatments, and outcome at last follow-up were collected. Outcomes included disease recurrence and death due to the disease. Prognostic value of clinic pathological features associated with disease-specific survival was obtained. Results Thirty-eight cases of head and neck cutaneous squamous cell carcinoma with parotid and/or neck metastasis were identified. Overall, 18 (47.3 %) patients showed parotid metastasis alone, 12 (31.5 %) exhibited neck metastasis alone and 8 (21.0 %) had both. A primary tumor in the parotid zone (Hazard Ratio ‒ HR = 5.53; p = 0.02) was associated with improved disease-specific survival. Poorer disease-specific survival was observed in patients with higher primary tumor diameter (HR = 1.54; p = 0.002), higher depth of invasion (HR = 2.89; p = 0.02), invasion beyond the subcutaneous fat (HR = 5.05; p = 0.002), neck metastasis at first presentation (HR = 8.74; p < 0.001), number of positive lymph nodes (HR = 1.25; p = 0.004), and higher TNM stages (HR = 7.13; p = 0.009). Patients presenting with isolated parotid metastasis during all follow-ups had better disease-specific survival than those with neck metastasis or both (HR = 3.12; p = 0.02). Conclusion Head and neck cutaneous squamous cell carcinoma with parotid lymph node metastasis demonstrated better outcomes than cases with neck metastasis.

Resumo Introdução As metástases regionais do carcinoma espinocelular cutâneo de cabeça e pescoço ocorrem em aproximadamente 5% dos casos, sendo esse o fator prognóstico mais importante na sobrevida, atualmente sem distinção entre metástases de parótida e cervicais. Objetivo Avaliar as características prognósticas em pacientes com carcinoma espinocelular cutâneo de cabeça e pescoço com metástase regional. Método Foi feita uma análise retrospectiva de pacientes com carcinoma espinocelular cutâneo submetidos à parotidectomia e/ou esvaziamento cervical entre 2011 e 2018 em um único centro terciário de uma única instituição. Dados demográficos dos pacientes, informações clínicas, cirúrgicas e patológicas, tratamentos adjuvantes e desfechos no último acompanhamento foram coletados. Os desfechos incluíram recorrência e morte devido à doença. O valor prognóstico das características clínico-patológicas associadas à sobrevida específica da doença foi obtido. Resultados Foram identificados 38 casos de carcinoma espinocelular cutâneo de cabeça e pescoço com metástase de parótida e/ou pescoço. No geral, 18 (47,3%) pacientes apresentaram metástase da parótida isolada, 12 (31,5%) apresentaram metástase cervical isolada e 8 (21,0%) apresentaram ambos. Um tumor primário na região da parótida (Hazard ratio [HR] = 5,53; p = 0,02) foi associado a melhor sobrevida específica. Pior sobrevida específica foi observada em pacientes com maior diâmetro do tumor primário (HR = 1,54; p = 0,002), maior profundidade de invasão (HR = 2,89; p = 0,02), invasão além da gordura subcutânea (HR = 5,05; p = 0,002), metástase cervical na primeira apresentação (HR = 8,74; p < 0,001), conforme maior número de linfonodos positivos (HR = 1,25; p = 0,004) e estágios TNM mais elevados (HR = 7,13; p = 0,009). Os pacientes que apresentaram metástase da parótida isolada durante todo o acompanhamento apresentaram melhor sobrevida específica do que aqueles com metástase cervical ou ambos (HR = 3,12; p = 0,02). Conclusão Os casos de carcinoma espinocelular cutâneo de cabeça e pescoço com metástase intraparotídea demonstraram melhores desfechos do que aqueles com metástase cervical.

Platysma transverse myocutaneous flap: a 21 case series of an overlooked reconstructive method for facial skin defects / Retalho miocutâneo transverso de platisma: casuística de 21 casos de um método pouco usual de reconstrução de defeitos de pele facial

Abstract Introduction Since the first report of a platysma transverse myocutaneous flap in 1977, few articles about this flap design have been added to the literature. Objective Our aim is to describe our department's experience with platysma transverse myocutaneous flap. Methods A retrospective review of all patients undergoing platysma transverse myocutaneous flap reconstruction between 2011 and 2019. Results There were 16 men and 5 women in this series. The mean patients' age was 72.7 years old. In eight cases, we had wound complications, including four wound infections, one hematoma and three distal flap ischemia problems. Distal flap ischemia occurred only in cases that advanced beyond the midline and with length-to-width ratio equal to or over three to one. Neck dissection was performed in two of these three cases with ischemic complications. Conclusion Several factors may influence platysma transverse myocutaneous flap survival. Usually a long and narrow flap, especially crossing the neck midline and associated with neck dissection are more prone to poor outcomes.

Resumo Introdução Desde o primeiro relato de retalho miocutâneo transverso de platisma em 1977, poucos artigos sobre o assunto foram adicionados à literatura. Objetivo Descrever a experiência de nosso departamento com retalho miocutâneo transverso de platisma. Método Análise retrospectiva de todos os pacientes submetidos à reconstrução por retalho miocutâneo transverso de platisma entre 2011 e 2019. Resultados Havia 16 homens e 5 mulheres. A idade média dos pacientes foi 72,7 anos. Em oito casos, ocorreram complicações no sítio operatório: quatro infecções no sítio operatório, um hematoma e três isquemias distais do retalho. A isquemia distal do retalho ocorreu apenas nos casos em que os mesmos progrediram para além da linha média e com proporção entre comprimento e largura superior ou igual a três. A dissecção do pescoço foi feita em dois desses três casos de complicações isquêmicas. Conclusão Diversos fatores podem afetar a vitalidade do retalho miocutâneo transverso de platisma. Normalmente, um retalho longo e estreito que passa pela linha média do pescoço e está associado à dissecção do pescoço está mais propenso a resultados negativos.

Total rhinectomy for nasal carcinomas / Rinectomia total para carcinomas nasais

Abstract Introduction: Total rhinectomy is an uncommon procedure for the treatment of nasal malignancies, usually reserved for locally advanced tumors. There are few case series studying total rhinectomy in the literature, reporting conflicting results about recurrence and metastasis. Objective: Evaluate prognosis of total rhinectomy cases for malignant neoplasia in our institution. Methods: Retrospective review from January 2013 to September 2018, including all patients undergoing total rhinectomy in our Institution, under the care of the Head and Neck surgical team. Results: Ten patients were included, two men and eight women. The mean patient age was 71.6 years old. The majority had nasal skin (8 cases) carcinomas. Squamous cell carcinoma was present in seven cases. In total, six cases had regional metastasis, in a median period of 14.3 months. The overall mortality and disease specific mortality was 50% and 30%, respectively, in a median follow-up of 45.7 months. Conclusion: We observed high overall and disease-specific mortality among cases with advanced nasal malignancies undergoing total rhinectomy.

Resumo Introdução: A rinectomia total é um procedimento incomum para o tratamento de neoplasias nasais, geralmente reservado para tumores localmente avançados. Há poucas séries de casos que estudam a rinectomia total na literatura, as quais descrevem resultados conflitantes sobre recorrência e metástase. Objetivo: Avaliar o prognóstico de pacientes submetidos a rinectomia total por neoplasia maligna em nossa instituição. Método: Revisão retrospectiva de janeiro de 2013 a setembro de 2018, incluiu todos os pacientes submetidos a rinectomia total em nossa instituição, sob os cuidados da equipe de cirurgia de cabeça e pescoço. Resultados: Dez pacientes foram incluídos, dois homens e oito mulheres. A média de idade dos pacientes foi de 71,6 anos. A maioria apresentava carcinoma da pele nasal (oito casos). O carcinoma espinocelular estava presente em sete casos. Seis casos tiveram metástase regional em um período mediano de 14,3 meses. A mortalidade geral e a mortalidade específica da doença foram de 50% e 30%, respectivamente; o acompanhamento médio foi de 45,7 meses. Conclusão: Observamos alta mortalidade geral e específica da doença entre os casos com neoplasias nasais avançadas submetidas à rinectomia total.

Ortner's syndrome

Inferior laryngeal nerve palsy is a relatively common entity. Nevertheless, an occurrence as a result of a cardiovascular pathology is rare. In this case, it is called Ortner's syndrome (OS). Aortic diseases are responsible for more than half of cases. Supraaortic vessels disorders are rare causes of OS. In our new report, a non-smoker and non-drinker 70-year-old woman presented with a history of dysphonia since childhood. On direct laryngoscopy, a left vocal cord paralysis was detected and a contrast-enhanced computed tomography showed an aberrant right subclavian artery originating from the left portion of the aortic arch. Its course to its usual site runs behind the esophagus, being also called arteria lusoria. In this particular case, two unusual situations appear together, which contributes to the rarity of the event.(AU)

A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features / Modelo preditivo para diferenciação entre nódulos malignos e benignos da tireoide com base na idade, sexo e características ultrassonográficas

Abstract Introduction: A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. Objective: The purpose of this study was to create a statistical prediction model for thyroid nodules management. Methods: Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. Results: In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. Conclusions: The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.

Resumo Introdução: Persiste na literatura uma discussão sobre uma ferramenta padronizada de apoio à decisão para o manejo de nódulos tireoidianos. Objetivo: Criar um modelo de previsão estatística para o manejo de nódulos tireoidianos. Método: Foram selecionados 204 casos de nódulos tireoidianos benignos e 57 malignos para o estudo retrospectivo. As variáveis idade, sexo e características ultrassonográficas foram analisadas com modelos univariados e multivariados. Uma fórmula estatística foi usada para calcular o risco de câncer de cada caso. Resultados: Na análise multivariada, a forma irregular, a ausência de halo, menor idadesubp média, ecotextura homogênea, microcalcificações e conteúdo sólido foram associadas ao câncer. Após a aplicação da fórmula, foram encontrados 20 casos (7,6%) com risco calculado de malignidade ≤ 3,0%, todos benignos. Definiu-se o risco calculado em ≥ 80%, 21 casos (8,0%) foram selecionados e em 85,7% deles o câncer foi confirmado pela histopatologia. A precisão interna da fórmula de previsão foi de 92,5%. Conclusões: A fórmula de previsão alcançou alta precisão e pode ser uma opção para outras ferramentas de apoio à decisão para o manejo de nódulos da tireoide.

Thyroid Carcinoma Pattern Presentation According to Age

Abstract Introduction Patients with thyroid cancer in different age groups present with different prognosis. Objective The objective of this study is to analyze the clinicopathological pattern of thyroid carcinoma presentation according to age groups. Methods This is a retrospective study. From 2000 to 2010, 623 patients underwent thyroidectomy for cancer in our institution, with 596 enrolled. Patients were divided into groups of 10 years and then in four age subgroups (≤ 24, 25-44, 45-64, and ≥65 years) for statistical analysis. We compared age, gender, and histopathological characteristics between groups. Results Individuals belonging to the earlier age group presented with a highest prevalence of neuro-vascular invasion, capsular invasion and lymph node metastasis. Together with individuals of advanced age, that group also had larger tumor diameter and higher prevalence of extra-glandular disease. Even when analyzed only cases with well-differentiated carcinoma, younger individuals remain with a highest prevalence of lymph node metastasis, neuro-vascular invasion and larger tumor diameter. Conclusion We observed a distinct pattern of clinicopathological manifestation of thyroid cancer according to age. Individuals belonging to age extremes resemble in several pathological features, and young people usually present with more aggressive disease characteristics.

Histopathological differences between genders in patients with oral squamous cell carcinoma

Introduction: Oral cancer ranks fifth among the most frequent malignant tumors in men in Brazil. The incidence of this tumor among women has grown. It is still controversial whether gender can influence the outcome or the prognostic features of the disease. Objectives: To compare the histopathological features of oral squamous cell carcinomas between genders among patients undergoing surgical treatment in an oncological hospital of southern Brazil. Methods: Between 2007 and 2011, 404 patients underwent resection of malignant tumors of the oral cavity in the head and neck department of this institution. A subgroup of 209 previously untreated oral cavity squamous cell carcinoma cases was selected for comparative analysis. Results: In total, 68 participants were women and 141 were men. The tongue was the most common subsite in both genders. Men presented lower mean age and women presented tumors with smaller depth of invasion. Although among women it was observed a trend towards tumors with less aggressive characteristics, no other variable showed statistically significance. Conclusion: Women with oral tumors tend to present more superficial primary tumors and at a later age (AU)

Fulminant auricular mucormycosis in a diabetic patient

Human mucormycosis is an atypical fungal infection that commonly affects the skin, but rarely the auricular region. A 32-year-old diabetic woman, agricultural worker, was admitted with swelling, redness and mild signs of epidermolysis of the left ear, associated with intense pain, facial paralysis and septic signs. The ear cellulitis evolved into necrosis of the same region on the following day. Surgical debridement was performed and antimycotic therapy was started with poor response. The patient died in 48h. Culture was confirmatory for Rhizopus sp. (AU)

Case report: tongue gangrene and oropharyngeal carcinoma

Gangrene of the tongue is a condition rarely described in the literature. It generally occurs in association with temporal arteritis and other vasculitides. We described a rare case of tongue necrosis associated with oropharyngeal carcinoma. A 67-male patient, previously submitted to exclusive radiotherapy for a squamous cell carcinoma of the tonsillar region, was admitted to our service with high dysphagia. Computed tomography showed circumferential swelling of the oropharynx, with areas of diffuse contrast uptake and significant reduction of the vascular flow at this level, especially venous return. About 6 months after the onset of symptoms, he was submitted to an urgent tracheostomy for airway obstruction. Then, about 1 month after tracheotomy, the neck skin became ecchymotic, congested, and he started with profuse oropharyngeal bleeding and congestion and thrombosis signs in the tongue. To our knowledge, this entity has not been yet described in the literature (AU)

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010 / Análise do padrão de ocorrência do carcinoma de tireoide entre 2000-2010

ABSTRACT INTRODUCTION: An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE: To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS: Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS: An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION: There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

RESUMO Introdução: Persiste uma discussão na literatura sobre as razões para as mudanças no padrão de incidência do carcinoma de tireoide nas últimas décadas. Objetivo: Analisar as características clinicopatológicas dos casos de carcinoma de tireoide ao longo de uma década. Método: Estudo transversal sobre uma coorte histórica. Os registros médicos de 628 casos de câncer de tireoide de um único centro foram revisados. Foram incluídos 597 pacientes. Os casos de microcarcinoma foram selecionados para uma fase de análise qualitativa, na qual os registros médicos foram revisados para melhor entendimento do processo de diagnóstico do nódulo e do câncer. Resultados: Observamos um aumento na proporção de casos com diagnóstico de câncer de tireoide ao longo da década; os novos casos foram predominantemente de tumores < 2 cm, com sinais histopatológicos de baixa agressividade. Houve aumento na proporção de casos com resultado citológico maligno entre os microcarcinomas. Conclusão: Há uma tendência de crescimento nas tireoidectomias por câncer na nossa instituição, com incremento proporcional de casos com características histopatológicas indicativas de doença precoce. Entre os microcarcinomas, há um grupo em ascensão representado por casos com diagnóstico não-ocasional de câncer, relacionados à melhora dos métodos diagnósticos pré-operatórios.

Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease? / Carcinoma papilífero da tireoide: a associação com tireoidite de Hashimoto influencia nas características clínico-patológicas da doença?

INTRODUCTION: Papillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial. OBJECTIVE: To evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis. METHODS: Cross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study. RESULTS: A total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging. CONCLUSIONS: A high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes. .

INTRODUÇÃO: O carcinoma papilífero é a neoplasia maligna mais comum da tireóide. O efeito da coexistência da tireoidite de Hashimoto (TH) no prognóstico do carcinoma papilífero da tireóide (CPT) permanece controverso. OBJETIVO: Avaliar a associação entre TH e parâmetros clínico-patológicos entre pacientes com diagnóstico de carcinoma papilífero da tireóide obtidos através da análise de uma série histórica institucional. MÉTODO: Coorte transversal com base em uma coorte histórica, envolvendo todos os casos submetidos à tireoidectomia total por motivo de carcinoma papilífero, realizadas na mesma Instituição ao longo de 11 anos. RESULTADOS: Um total de 417 pacientes foram incluídos no estudo, estando 148 (35,4%) associados à TH. Observamos preponderância de mulheres entre os casos associados à TH. Esses casos se apresentaram com menor média de diâmetro tumoral, menor frequência de comprometimento extra-tireoidiano e estadiamento clínico-patológico mais precoce. Conclusões: Um percentual expressivo de casos de CPT apresenta-se associado à TH. A associa ção entre esses casos com vários fatores histopatológicos já reconhecidos por seu valor prognóstico, pode, por si só, influenciar no desfecho desses pacientes. .

Tumor fibroso solitário de laringe: relato de dois novos / Solitary fibrous tumor of the larynx: report of two new cases

Solitary fibrous tumor is a rare neoplasm. Few cases have been described in the head and neck area, and less than 11 were located in the larynx. We described two new cases of solitary fibrous tumor of the larynx. A man, 64-year-old, and a woman, 77-year-old, both with submucosal and nodular supraglottic lesions, were submitted to surgical treatment and both showed CD-34 and bcl-2 immunoreactivity and S-100 and smooth-muscle actin negativity. After 24 and 22 months of postoperative follow-up, respectively, they did not show signs of active disease...

O tumor fibroso solitário é uma neoplasia rara. Foram descritos poucos casos em cabeça e pescoço, sendo não mais de 11 na laringe. Descrevemos dois novos casos de tumor fibroso solitário da laringe, um em um homem de 64 anos e outro em uma mulher de 77 anos, ambos com lesões supraglóticas submucosas e nodulares. Os casos foram submetidos a tratamento cirúrgico e ambos apresentaram imunorreatividade a CD-34 e bcl-2, e negatividade para S-100 e actina de músculo liso. Após 24 e 22 meses de seguimento pós-operatório, respectivamente, não apresentam sinais de doença em atividade...

Variantes do carcinoma papilifero da tireoide: associacao com fatores prognosticos histopatologicos / Variants of papillary thyroid carcinoma: association with histopathological prognostic factors

O carcinoma papilífero é a malignidade tireoidiana mais comum. Muitas variantes desse tumor foram descritas, com diferentes características morfológicas e moleculares. Embora a maioria dos casos apresente um excelente prognóstico, a relação entre a arquitetura tumoral e o comportamento biológico dessas neoplasias ainda permanece controversa. OBJETIVO: Apresentamos a experiência de um único serviço acerca da prevalência das variantes do carcinoma papilífero da tireoide e sua relação com os demais fatores prognósticos histopatológicos. MÉTODO: Estudo retrospectivo envolvendo todos os casos submetidos à tireoidectomia por carcinoma papilífero na mesma Instituição ao longo de 11 anos de estudo. RESULTADOS: Foram incluídos 517 pacientes, sendo 81,9% dos casos representados mulheres. A média de idade foi de 47,2 anos. As variantes reconhecidas por terem maior potencial de agressividade corresponderam a 5,6% da amostra. Observamos associação desses subtipos tumorais com maior diâmetro da lesão, estadiamento T, invasão linfovascular e da cápsula da glândula. CONCLUSÃO: Um pequeno percentual de casos de carcinomas papilíferos é representado por variantes reconhecidas por seu maior potencial de agressividade. Existem associações entre essas variantes e diversos outros fatores histopatológicos já reconhecidos por seu valor prognóstico, o que pode, por si, só influenciar no desfecho desses casos. .

Papillary carcinoma is the most common thyroid malignancy. Many variants of this tumor have been described, with different morphological and molecular characteristics. Although most cases have excellent prognosis, the relationship between tumor architecture and its biological behavior remains controversial. OBJECTIVE: To present the experience of a single center on the prevalence of thyroid papillary carcinoma variants and their relationship with other histopathological prognostic factors. METHOD: Retrospective study of all the cases submitted to thyroidectomy for papillary carcinoma in the same institution over 11 years. RESULTS: We included 517 patients, 81.9% of them were women. The average age was 47.2 years. The variants recognized to have higher aggressiveness potential corresponded to 5.6% of the sample. We found an association of tumor subtypes with greater lesion diameter, T staging, lymphovascular and gland capsule invasion. CONCLUSION: A small percentage of papillary carcinoma cases is represented by variants recognized by their greater potential for aggression. There are associations between these variants and several other histopathological factors already recognized for their prognostic value, which may, by themselves, influence the outcome of these cases. .

Correlação entre dados clínico-patológicos e margens cirúrgicas em pacientes com carcinoma epidermoide da cavidade oral / Correlation between clinical and pathological data and surgical margins in patients with squamous cell carcinoma of the oral cavity

Há décadas se conhece a importância de se obter margens livres de neoplasia quando da ressecção de neoplasias de boca. OBJETIVO: Correlacionar achados clínico-patológicos com status de margem cirúrgica em pacientes com carcinoma espinocelular da língua e do assoalho da boca. MÉTODO: Forma de estudo: Estudo de coorte histórico, com corte transversal, envolvendo todos os pacientes submetidos à ressecção de carcinomas espinocelulares da língua oral e assoalho bucal entre os anos de 2007 e 2011 pelo Serviço de Cirurgia de Cabeça e Pescoço da nossa Instituição. RESULTADOS: Foram incluídos 117 casos, sendo 68.3% dos tumores localizados na língua. A relação homem:mulher foi de 2.3:1 e a média de idade foi de 57,6 anos. Ao todo, 23,0% dos casos tiveram margens de ressecção livres e amplas, 60,6% exíguas e 16,2% comprometidas. Diâmetro tumoral e espessura apresentaram correlação com margens de ressecção, sendo os tumores de estádio T mais elevados mais propensos à ressecção com margem insatisfatória. Casos operados com margens livres e amplas tiveram seus tumores ressecados mais comumente com técnicas trans-orais. CONCLUSÕES: Evidenciamos correlação entre tumores de maior volume, tanto em diâmetro quanto em espessura, com margens de ressecção insatisfatórias. Técnicas cirúrgicas de maior complexidade não tiveram associação com melhores margens de ressecção.

The importance of having tumor-free margins when resecting oral neoplasms has been known for decades. OBJECTIVE: To correlate clinical and pathology data to surgical margin status in patients with squamous cell carcinoma of the tongue and floor of the mouth. METHOD: This historical cohort cross-sectional study included all patients submitted to squamous cell carcinoma resection for tumors of the oral tongue and floor of the mouth between 2007 and 2011 at the Head and Neck Surgery service of our institution. RESULTS: In the 117 cases included, 68.3% had tongue tumors. The male-to-female ratio was 2.3:1 and patient mean age was 57.6 years. Broad free resection margins were seen in 23.0% of the cases; narrow margins in 60.6% of the cases; and compromised margins in 16.2%. Tumor diameter and thickness were correlated to resection margins. Tumors in more advanced T-stages presented more unsatisfactory margins. Patients operated with broad free margins had their tumors resected more commonly through transoral approaches. CONCLUSIONS: Tumors of larger volume both in terms of diameter and thickness were more correlated to unsatisfactory resection margins. Higher complexity procedures were not associated with better resection margins.

Teratoma imaturo de ovário na gestação: relato de caso e revisão da literatura / Immature ovarian teratoma in pregnancy: case report and literature review

O teratoma imaturo de ovário é uma neoplasia maligna derivada de células embrionárias de diferenciação somática. Sua incidência é baixa, e rara em gestantes. Costuma se manifestar em pacientes jovens, sendo, frequentemente, assintomáticos. Relata-se aqui o caso de uma paciente de 21 anos que veio à consulta apresentando ecografia obstétrica de 25 semanas, com presença de massa anexial à esquerda. Uma nova ecografia, realizada dois dias após a primeira avaliação, revelou massa de aspecto heterogêneo, sólido-cístico, septada, com 9,4cm em seu maior diâmetro. Havia presença de líquido livre na cavidade abdominal, ocupada por formações teciduais de distribuição ampla. Duas semanas após a primeira consulta, foi submetida à laparotomia exploradora com salpingo-ooforectomia unilateral e ressecção de implantes peritoneais, obtendo citorredução ótima. O laudo histopatológico revelou teratoma imaturo de ovário grau III, com líquido de ascite negativo para células malignas. Realizados 3 ciclos de quimioterapia adjuvante, segundo protocolo BEP (bleomicina, etoposide e cisplatina), os dois primeiros com a gestação em curso. Com 36 semanas de gestação, iniciou-se a indução de trabalho de parto, com boa evolução. O recém-nascido apresentou um índice de Apgar de 8/8, sem sinais de danos secundários à quimioterapia. No momento, a paciente encontra-se assintomática e livre de doença no décimo quarto mês pós-operatório. Acredita-se que esse trabalho possa acrescentar ao conhecimento atual da doença, visto a raridade do caso e a escassa quantidade de literatura disponível.