Cordoma sacrococcígeo en un paciente de mediana edad / Sacrococcigeal chordoma in a middle age patient

Se presenta el caso clínico de un hombre de 48 años de edad, quien fuera ingresado en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba en el 2007, por presentar dificultades para defecar. Según valoración clínico-radiológica, se diagnosticó un cordoma sacrococcígeo y fue egresado debido al estadio del tumor, con indicación de seguimiento en consulta externa. En el mes de julio de ese mismo año se le hospitalizó en el Instituto Nacional de Oncología y Radiología, donde fue intervenido quirúrgicamente. Un año más tarde fue ingresado en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso", con signos de recidiva tumoral de gran extensión. Falleció 6 meses después.

The case report of a 48 year-old man who was admitted in "Dr. Joaquín Castillo Duany" Teaching Clinical Surgical Hospital from Santiago de Cuba in the 2007 is presented, due to difficulties for defecating. According to a clinical-radiological evaluation, a sacrococcigeal chordoma was diagnosed and he was discharged due to the tumor stage, with the indication of follow up through out patient department. In the month of July of that same year, he was hospitalized in the National Institute of Oncology and Radiology, where he was surgically treated. A year later, he was admitted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital, with signs of tumor relapse of great extension. He died 6 months later.

Avaliação oncológica após reconstrução mamária com lipoenxertia / Oncologic evaluation after breast reconstruction with fat grafting

Introdução: A reconstrução mamária é etapa fundamental no tratamento de pacientes com câncer de mama, sendo a lipoenxertia um importante recurso para melhora no resultado estético. Todavia, recentemente, alguns autores têm questionado a segurança da lipoenxertia, sugerindo que essa técnica possa aumentar o risco de recidiva tumoral local. Métodos: Estudo retrospectivo, tipo coorte transversal, realizado por meio de revisão de prontuários médicos de pacientes submetidas a reconstrução mamária com lipoenxertia pela Divisão de Cirurgia Plástica do Hospital das Clínicas da FMRP-USP, no período de 2006 a 2010. Resultados: Foram selecionadas 18 pacientes, sendo que oito (44%) apresentaram tumor do tipo histológico ductal. Três pacientes (17%) foram submetidas a quimioterapia neoadjuvante, sendo que destas, duas (11%) foram submetidas também a quimioterapia adjuvante; nove (50%) foram submetidas apenas a quimioterapia adjuvante. Onze pacientes (61%) foram submetidas a radioterapia adjuvante, e treze (72%) fizeram tratamento hormonal. Quanto à reconstrução da mama, oito pacientes (44,4%) realizaram TRAM, seis (33,3%), expansor mais prótese e quatro (22,2%), grande dorsal mais prótese. O número de sessões de lipoenxertia variou entre um e quatro. Não foi identificado nenhum caso de recidiva tumoral locorregional. Conclusão: Não foi evidenciado nenhum caso de recidiva tumoral locorregional, o que acrescenta, até o momento, confiabilidade e segurança à lipoenxertia como arsenal para os procedimentos que visam melhorar os resultados da reconstrução mamária após o tratamento oncológico.

Introduction: Breast reconstruction is an essential step in the treatment of patients with breast cancer. Fat grafting is an important resource for improved esthetic results. Recently, however, some authors have questioned the safety of fat grafting, suggestoncolóing that this technique can increase the risk of local tumor recurrence. Methods: A retrospective, cross-sectional cohort study was conducted through a review of medical records of patients who underwent breast reconstruction with fat grafting by the Plastic Surgery Division of the Clinical Hospital of the Ribeirão Preto Faculty of Medicine of the University of São Paulo (FMRP-USP), from 2006 to 2010. Results: We selected 18 patients, of whom eight (44%) had ductal carcinoma by histology. Three patients (17%) underwent neoadjuvant chemotherapy, and of these, two (11%) were also subjected to adjuvant chemotherapy. Nine (50%) received only adjuvant chemotherapy. Eleven patients (61%) underwent adjuvant radiotherapy, and thirteen (72%) had hormonal therapy. For breast reconstruction, eight patients (44.4%) underwent a transverse rectus abdominis myocutaneous (TRAM) flap procedure, six (33.3%) had an expander and prostheses, and four (22.2%) underwent a procedure with the latissimus dorsi muscle flap and prostheses. The number of fat grafting sessions ranged from one to four. No cases of locoregional recurrence of breast cancer were identified. Conclusion: There has been no evidence of locoregional recurrence to date, demonstrating that fat grafting is a reliable and safe procedure for improving the results of breast reconstruction after cancer treatment.

Quimioprofilaxis en la recidiva tumoral vesical / Chemoprophylaxis in the vesical tumoral recurrence

Los tumores vesicales superficiales se caracterizan por una alta tasa de recidiva, que ocurre especialmente dentro de los dos primeros años, y que es aun mayor en los grupos de alto riesgo. Existe consenso en la utilidad del uso del Bacilo de Calmette-Guerin para disminuir la recurrencia tumoral. La quimioterapia intravesical con otros medicamentos han demostrado su utilidad o no en disminuir la recurrencia de estos tumores vesicales. Entre los años 1999 y 2008 se estudian y tratan 110 pacientes (96 hombres y 14 mujeres), con una edad promedio de 63 años, divididos en tres grupos para tratamiento de la recidiva tumoral después de resección transuretral o cistectomía parcial, con tres diferentes agentes quimioprofilácticos e inmunomoduladores (Thio-Tepa, BCG+factor de transferencia, doxorrubicina+interferón alfa 2b). El objetivo de esta investigación fue presentar la experiencia en el tratamiento de estos pacientes, donde se observa mejores resultados en 5 años, con el grupo tratado con doxorrubicina+interferón alfa 2b, seguido del grupo tratado con BCG+factor de transferencia, con una marcada disminución de las recurrencias y una limitación en la progresión de la enfermedad a largo plazo.

The superficial bladder tumors are characterized by a high rate of recurrence taking place especially within the first two years that is even higher in the high risk groups. There is an agreement in the usefulness of the Calmette-Guerin Bacillus (CGB) to diminish the tumoral recurrence. The intravesical chemotherapy with other medications have demonstrated its profit or not in decreasing the recurrence of these bladder tumors. Between 1999 and 2008 we studied and treated 110 patients (96 men and 14 women), aged in average 63 years old. They were divided into three groups for the treatment of the tumoral recidivism after the transurethral resection or partial cystectomy, using three different chemoprophylactic agents and inmunomodulators (Thio-Tepa, BCG+Transference Factor, Doxorubicin +Interferon Alpha 2b). The objective of this research was presenting our experience in the treatment of these patients during five years, obtaining better results in the group treated with doxorubicin + interferon alpha 2b, followed by the group treated by means of BCG + transference factor, with a remarked decrease of the recurrence and a limitation in the long term progression of the disease.

Análise de 5 anos de seguimento de hepatectomias em portadores de turmor hepático / Analysis of 5 years following hepatectomy in patients with liver tumor

Introdução: os tumores hepáticos malignos são muito mais comuns do que os benignos, sendo os metastáticos ou secundários 20 vezes mais frequentes do que os primários. A hepatectomia permanece como o principal e mais utilizado método de tratamento dos tumores hepáticos. Infelizmente, esse método é aplicável apenas em cerca de 10% dos casos. Analisar a sobrevida dos pacientes portadores de tumor hepático submetidos a ressecções hepáticas no Estado do Amazonas, assim como as principais complicações pós-operatórias e índice de recidiva tumoral. Métodos: estudo retrospectivo, analisando os prontuários e laudos anatomopatológicos dos pacientes submetidos à ressecção hepática na Fundação Centro de Controle de Oncologia do Amazonas (FCECON), entre janeiro de 2006 a dezembro de 2010. Resultados: foram realizadas 34 ressecções hepáticas, sendo 55,9% tumores malignos primários do fígado, 26,5% doença metastática e 17,6% tumores benignos. Houve 17,64% de complicações pós-operatórias, sendo as mais graves o abscesso subfrênico e a hemorragia intra-abdominal. A taxa de reoperação foi de 2,94%. Não houve mortalidade operatória. O índice de recidiva tumoral foi de 23,5%, com óbito ocorrendo em 75% destes casos. A taxa de sobrevida em um, três e cinco anos foi respectivamente 96%, 89% e 68%. Conclusão: a cirurgia hepática tem se tornado cada vez mais factível e as complicações pós-operatórias, sob maior controle clínico, tem diminuído consideravelmente a mortalidade.

Introduction: malignant Hepatic tumors are much more common than the benign ones, being the metastatics 20 times more frequent than the primaries. Hepatectomy remains as the more common and used method in its treatment. Unfortunately this method can be applied in around 10% of cases. To analyze the overall survival of malignant liver tumors patients who underwent a hepatic resection in the state of Amazonas, as well as the post-operative complications and recurrence rate. Methods: retrospective study, analysing the patient records and anatomopathologic reports of patients who underwent liver resection in Fundação Centro de Controle de Oncologia do Amazonas (FCECON), between january 2006 and december 2010. Results: a total amount of 34 liver resections were done, being 55,9% liver primary malignant tumors, 26,5% metastatic disease e 17,6% benign tumors. There were 17,64% of post-operative complications, being the more serious diaphragmatic abscess and intra-abdominal bleeding. Reoperation rate was of 2,94%. There were no preoperative mortality. Tumor recurrence was 23,5%, with death happening in 75% of these cases. Overall survival in one, three and five years were respectively 96%, 89% e 68%. Conclusion: hepatic surgery has been increasingly more appliable and post-operative complications, under strict clinical care, has considerably diminished mortality.

Recidiva tumoral em pálpebra inferior previamente reconstruída: opção para reconstrução total / Tumoral recurrence in a previously reconstructed lower eyelid: option for total reconstruction

A reconstrução das pálpebras apresenta-se sempre como um grande desafio ao cirurgião plástico devido à complexidade anatômica da região, bem como da necessidade fundamental de preservação da função, principalmente proteção do globo ocular. Os autores relatam caso de paciente submetida à reconstrução total de pálpebra inferior já previamente reconstruída. São discutidos aspectos relevantes na reconstrução total da pálpebra inferior, objetivando-se demonstrar como a associação de diversas técnicas cirúrgicas reparadoras aliadas ao conhecimento da complexa anatomia dessa região podem propiciar resultados funcionais e estéticos satisfatórios.

The reconstruction of the eyelids always poses a major challenge to the plastic surgeon due to the anatomic complexity of the region, as well as the fundamental need to preserve its function, mainly protection of the eyeball. Here the authors reported a case of a patient undergoing total reconstruction of a previously reconstructed lower eyelid. Relevant aspects are discussed in the full reconstruction of the lower eyelid, aiming to demonstrate how the combination of several surgical techniques combined with the knowledge of the complex anatomy of this region can provide satisfactory functional and aesthetic results.

La recidiva tumoral en la reconstrucción nasal oncológica / Tumor relapse present in oncologic nasal repair

INTRODUCCIÓN. La recidiva tumoral es una de las complicaciones más temidas de la evolución oncológica, y además de ensombrecer el pronóstico de vida, causa la pérdida de muchas reconstrucciones y agota las posibilidades quirúrgicas restauradoras. Este estudio tuvo el objetivo de determinar la frecuencia de recidivas, la repercusión sobre la reconstrucción y la evolución médica posterior de pacientes operados de tumoraciones nasales malignas. MÉTODOS. Se realizó un estudio descriptivo retrospectivo, con 20 pacientes operados de tumoraciones nasales malignas, con reconstrucción inmediata con colgajo frontal. Los pacientes procedían del Instituto Nacional de Oncología y Radiobiología (INOR), donde fueron atendidos entre el año 2002 y el 2007. RESULTADOS. Hubo recidivas en 5 pacientes (25 por ciento de la muestra) y el 80 por ciento de estas eran un carcinoma epidermoide. Todos los pacientes con recidiva perdieron los tejidos reconstruidos y recibieron tratamiento con radioterapia. Solo se pudo reconstruir nuevamente el defecto de uno de los pacientes; dos de los restantes fallecieron y dos continuaban vivos, sin recurrencia del tumor pero sin posibilidades de reconstrucción. CONCLUSIONES. Teniendo en cuenta la frecuencia de recidivas de los carcinomas epidermoides nasales y de su repercusión, cuando no se cuenta con la técnica histográfica de Mhos, se sugiere posponer la reconstrucción nasal hasta tanto no se realice la confirmación histológica de la exéresis completa del tumor(AU)

INTRODUCTION: Tumor relapse is one of the more fearsome complications of the oncologic course and also to obscure the life prognosis, causing the loss of many reconstructions and of exhausting the repairing surgical possibilities. The aim of this study was to determine the relapse frequency, the repercussion on the repair and the subsequent medical course of patients operated on malign nasal tumors. METHODS: We made a retrospective and descriptive study in 20 patients operated on malign nasal tumors with immediate repair using frontal flap. Patients came from National Institute of Oncology and Radiobiology (NIOR), where they were seen from 2002 and 2007. RESULTS: There were two relapses in 5 patients (25 percent of total), and the 80 percent of these were an epidermoid carcinoma. All patients with relapse lost the repaired tissues and received radiotherapy. Only it was possible to repair the defect in one of the patients; two of remained deceased, and were alive, without tumor relapse but without possibilities of repair. CONCLUSIONS: Considering the relapse frequency of nasal epidermoid carcinomas and of its repercussions when the Mhos histography technique is not available, it is advisable to delay the nasal repair until will be possible to confirm completely the histology of tumor exeresis(AU)

Evaluación del corregistro de imágenes de resonancia magnética y tomografía por emisión de positrones con 2-desoxy-2-flúor-d-glucosa marcada con flúor-18 en pacientes con patología tumoral cerebral / Validation of MRI and 18F-FDG-PET coregistration in patients with primary brain tumors

Objetivo: Determinar la efectividad del co-registro de imágenes PET/RM (tomografía de emisión de positrones y resonancia magnética) en el diagnóstico de recidiva tumoral vs.. radionecrosis en pacientes con patología tumoral cerebral primaria previamente tratados. Material y métodos: El diagnóstico de tumor cerebral se determinó por RM e histopatología. Después de 3 a 5 meses postratamiento se realizó RM y PET como parte del seguimiento. El análisis de dichas imágenes se hizo de manera visual y semicuantitativa mediante la obtención de un índice de captación de 18F-FDG de tejido tumoral/ tejido cerebral sano. Resultados: Se estudiaron 57 pacientes; un total de 37 gliomas astrocíticos, 9 gliomas mixtos, 5 tumores embrionarios, 1 tumor meníngeo y 1 tumor oligodendroglial . Todas las imágenes de RM presentaban áreas de reforzamiento, dejando sospecha entre radionecrosis o viabilidad tumoral; con el co-registro PET/RM se diagnosticaron 21 estudios negativos (30 %) y 36 positivos (70 %). El índice tejido tumoral/tejido cerebral sano se correlacionó adecuadamente con los resultados visuales obtenidos. Conclusión: La RM sobreestima el área tumoral a valorar. La presencia de la actividad metabólica analizada mediante PET sobre las áreas de reforzamiento por RM permite determinar la presencia de viabilidad tumoral. Esto aumenta la certeza diagnóstica de ambas técnicas de imagen.

OBJECTIVE: To evaluate the role of PET and MRI fused image study inpatients with primary brain tumors previously treated, to determine the presence of radionecrosis vs residual tumor viability. METHODS: Primary brain tumors were diagnosed by biopse and MR. 18FDG-PET scan and T1 enhanced MRI follow-up studies were performed between 3 and 5 months after treatment. The 18F-FDG uptake was semiquantitavively calculated by a region-of-interest based Tumor hotspot/normal brain tissue index. RESULTS: Fifty-seven patients were studied, 37 had high grade gliomas; 9 had oligoastrocytomas; 5 had Embrionary tumors; I had a meningyoma and I had an oliodendroglial tumor. All MR studies showed tumor enhancement, without determine wether if it was radionecrosis or tumor viability. PET/MR fused study diagnosed 21 negative studies (30%) and 36 positive results (70%). Tumor hotspot/normal brain tissue index correlated well with the visual analysis registered. CONCLUSIONS: Visual analysis in the contrast enhanced MR overestimates the tumoral area, without defining a possible diagnosis between tumor viability and radionecrosis. Metabolic activity in the 18F-FDG PET study in the enhanced area, determines the presence of residual tumor viability. Therefore, coregistration can be used to obtain a more specific diagnosis optimizing the cinical use.

Cáncer de tiroides en SOLCA 1991-2000: estudio de resultados terapéuticos / Thyroid Cancer in SOLCA 1991-2000: study of therapeutic results

Tipo de estudio: Retrospectivo y comparativo en el hospital Dr. Juan Tanca Marengo ION SOLCA de la ciudad de Guayaquil, durante el período comprendido de enero de 1991 a diciembre del año 2000, sobre cáncer de tiroides.Objetivo: Comparar en dos grupos problema de 33 pacientes cada uno, variables referentes a sexo, edad, tipo histológico, y fundamentalmente el periodo de remisión tumoral entre dos terapéuticas que se presentaron durante estos diez años como parte del protocolo utilizado en la institución donde se llevó a cabo el estudio.Resultados: De 131 pacientes, 66 participaron en el estudio, pudiéndose constatar que es una patología con mayor incidencia en las mujeres relación mujer – hombre: 2.8–1, que si bien el tipo histológico fue contundentemente el carcinoma papilar, se observó una proporción idéntica entre el cáncer folicular y el cáncer anaplásico, dato que no se reporta normalmente en otros países. Finalmente y los más importante fue que pacientes que fueron solamente operados recidivaron en un 61% vs. un 15% en pacientes que posteriormente de la cirugía recibieron Yodo 131, concluyéndose que esta asociación es el tratamiento de elección para pacientes con cáncer diferenciado de tiroides sin importar edad y estadio de la enfermedad.Conclusiones: Mujeres menores de 40 años y económicamente activas fueron la mayor incidencia por lo que el factor hormonal y laboral esta relacionado en la etiología; la terapia combinada debe ser instaurada de forma sistemática a pacientes con Ca diferenciado de tiroides.

Type of study: Retrospective and comparative study at the Dr. Juan Tanca Marengo Hospital ION SOLCA in the city of Guayaquil, during the period of time between January of 1991 to December of the year 2000, in a group of patients with thyroid cancer.Objective: To compare two groups of 33 patients. The variables are: sex, age, histological type, and fundamentally the period of tumor remission between two therapeutic treatments that were presented during these ten years as part of the protocol used in the institution where the study was carried out.Results: Of 131 patients, 66 participated in the study, being able to verify that it is pathology with more incidences in the women. Where the ratio between woman - man: 2.8 - . Overwhelmingly the most frequent malignancy was the Papillary Carcinoma. An identical ratio was observed between follicular and anaplastic carcinoma a finding that is not usually reported in other countries. The most important finding was that patients that were solely operated recurred in 61% vs. only 15% in patients that after surgery they received Iodine 131. We conclude that this association of surgery and treatment with Iodine 131 is the goal treatment for patients with differentiated thyroid cancer without emphasis on age and stage of the illness.Conclusions: Women less than 40 years of age and economically active had a higher incidence due to the hormonal and labor factor which is associated with the etiology. Patients with Differentiated thyroid Cancer should receive the combined treatment.