Carcinoma escamoso híbrido de la planta del pie / Squamous hybrid carcinoma of the sole of the foot

Resumen El carcinoma escamoso (CEC) es un tumor maligno de la epidermis y sus anexos. Es el segundo en frecuencia después del carcinoma basocelular y presenta distintas variantes clinicopatológicas. El subtipo carcinoma verrucoso (CV) es una variante poco frecuente de CEC con características histopatológicas y comportamiento específico. Ocasionalmente, se pueden observar componentes carcinomatosos de células escamosas convencionales en el CV, denominándose a esta entidad tumores "híbridos", los cuales representan el 20% de los casos observados. Reportamos el caso de un paciente varón de 72 años con una gran lesión exofítica que compromete 5to dedo y planta de pie derecho con diagnóstico de carcinoma escamoso híbrido. El objetivo de la presentación es mostrar una asociación infrecuente, haciendo énfasis en su seguimiento cercano ya que puede manifestar cambios en su comportamiento clínico diseminándose a los ganglios linfáticos regionales.

Abstract Squamous carcinoma (SCC) is a malignant tumor of the epidermis and its appendages. It is the second most common after basal cell carcinoma and has different clinicopathological variants. The verrucous carcinoma (VC) subtype is a rare variant of SCC with histopathological characteristics and specific behavior. Occasionally, carcinomatous components of conventional squamous cells can be observed in the VC, this entity being called "hybridized" tumors, which represent 20% of cases.We report the case of a 72-year-old male with a large exophytic lesion involving the 5th right toe and foot with a diagnosis of squamous hybrid carcinoma. The objective of the presentation is to show an infrequent association, emphasizing its close follow-up as it can modify its clinical behavior by spreading to regional lymphnodes.

Carcinoma Escamoso Escrotal. Reporte de un caso / Squamous scrotal carcinoma. Report of a case

Se presenta el caso de un paciente de 47 años quien consultó por cuadro de cicatrización tórpida de una lesión cutánea superficial única en hemi-escroto izquierdo. Se procedió a resección biópsica de la lesión con resultado de la anatomía patológica de un Carcinoma Escamoso del tipo Condilomatoso (Warty) el cual confirma su relación con el HPV 16 mediante estudio de inmunohistoquímica. Por ser un caso infrecuente no existe actualmente un consenso sobre el manejo del carcinoma del escroto motivo el cual se realiza una revisión de la literatura y se expone los resultados.

A case of a 47-year-old patient who consulted for torpid healing of skin lesion in left hemi-scrotum is presented. We proceed to resection-biopsy of the lesion and the pathology report informed a warty squamous cell carcinoma (Warty type) and the relationship with HPV 16 is confirmed by immunohistochemical study. As a rare case there is currently no consensus on the management of carcinoma of the scrotum reason that we do a review of the literature and the results are exposed.

Impacto de la invasión perineural en pacientes con cáncer de lengua tratados en el Instituto Nacional de Oncología y Radiobiología / Impact of perineural invasion in patients with tongue cancer treated at the National Institute of Oncology and Radiobiology / Impacto da invasão perineural em pacientes com câncer de língua tratados no National Institute of Oncology and Radiobiology

RESUMEN El conocimiento de los factores pronósticos del carcinoma escamoso de cabeza y cuello es de gran importancia, pues ayudan a predecir el futuro evolutivo de la enfermedad y a comprender hechos de su fisiopatología también, permiten comparar tratamientos, agrupar a los pacientes con pronóstico semejante, diseñar ensayos clínicos incluso, seleccionar el tratamiento ideal para cada paciente. Se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo con el objetivo de evaluar el impacto de la invasión perineural en pacientes con cáncer de lengua tratados en el Instituto de Oncología y Radiobiología (INOR) con un universo de 62 pacientes. Se tuvieron en cuenta variables como: edad, sexo, color de la piel, grado histológico, etapa clínica, tipo de lesión, técnica quirúrgica utilizada y factores pronósticos mayores. Se establecieron 2 grupos uno sin presencia de invasión perineural y otro con invasión perineural. El mayor número de casos se presentó en el grupo de 55-64 años en ambos grupos, con mayor incidencia del sexo masculino y color de la piel blanca. El carcinoma epidermoide bien diferenciado prevaleció en ambos grupos con 54,3 % y 50,0. La técnica quirúrgica más utilizadas en el grupo de pacientes con presencia de invasión perineural fue las glosectomías parciales más disección selectiva de cuello, los bordes de sección quirúrgicos positivos fue el factor pronóstico mayor más frecuente en los pacientes con invasión perineural con 56,3 % y significación estadística p=0,021. Las recaídas, local, regional y a distancia, estuvieron presentes en todos los pacientes que presentaron la invasión perineural estadísticamente significativo p=0,010.

ABSTRACT Knowledge of the prognostic factors of squamous cell carcinoma of the head and neck is of great importance, as they help to predict the future evolution of the disease and to understand facts about its pathophysiology, they also allow comparing treatments, grouping patients with a similar prognosis, designing trials clinicians even select the ideal treatment for each patient. An observational, descriptive, longitudinal and retrospective study was carried out with the objective of evaluating the impact of perineural invasion in patients with tongue cancer treated at the Institute of Oncology and Radiobiology (INOR) with a universe of 62 patients. Variables such as: age, sex, skin color, histological grade, clinical stage, type of lesion, surgical technique used and major prognostic factors were taken into account. Two groups were established, one without the presence of perineural invasion and the other with perineural invasion. The highest number of cases occurred in the 55-64 age group in both groups, with a higher incidence of males and white skin color. Well-differentiated squamous cell carcinoma prevailed in both groups with 54.3% and 50.0. The surgical technique most used in the group of patients with the presence of perineural invasion was partial glosectomies plus selective neck dissection, positive surgical section margins were the most frequent major prognostic factor in patients with perineural invasion with 56.3% and statistical significance p = 0.021. Relapses, local, regional and distant, were present in all patients who presented statistically significant perineural invasion p = 0.010.

RESUMO O conhecimento dos fatores prognósticos do carcinoma espinocelular de cabeça e pescoço é de grande importância, pois ajudam a prever a evolução futura da doença e a compreender fatos sobre sua fisiopatologia, permitem também comparar tratamentos, agrupar pacientes com prognósticos semelhantes, delinear ensaios os médicos até selecionam o tratamento ideal para cada paciente. Foi realizado um estudo observacional, descritivo, longitudinal e retrospectivo com o objetivo de avaliar o impacto da invasão perineural em pacientes com câncer de língua atendidos no Instituto de Oncologia e Radiobiologia (INOR) com um universo de 62 pacientes. Foram consideradas variáveis ​​como: idade, sexo, cor da pele, grau histológico, estádio clínico, tipo de lesão, técnica cirúrgica utilizada e principais fatores prognósticos. Dois grupos foram estabelecidos, um sem presença de invasão perineural e outro com invasão perineural. O maior número de casos ocorreu na faixa etária de 55 a 64 anos em ambos os grupos, com maior incidência no sexo masculino e na cor da pele branca. O carcinoma espinocelular bem diferenciado prevaleceu em ambos os grupos com 54,3% e 50,0. A técnica cirúrgica mais utilizada no grupo de pacientes com presença de invasão perineural foi glosectomias parciais mais esvaziamento cervical seletivo, margens de secção cirúrgica positivas foram o principal fator prognóstico mais frequente em pacientes com invasão perineural com 56,3% e significância estatística p = 0,021. As recidivas, locais, regionais e à distância, estiveram presentes em todos os pacientes que apresentaram invasão perineural estatisticamente significativa p = 0,010.

Ulcera de Marjolin (carcinoma escamoso) sobre eventración abdominal / Marjolin ulcer (squamous carcinoma) over abdominal hernia

Introducción: Las úlceras de Marjolin son neoplasias cutáneas que asientan sobre pieles afectadas por úlceras crónicas, quemaduras, cicatrices, estasis venosa o heridas cutáneas. Generalmente se diagnostica por medio de biopsias, siendo los carcinomas escamosos la variedad más frecuente. Existe escasa información sobre su desarrollo en heridas quirúrgicas abdominales previas, y aún menos casos reportados de su aparición sobre un defecto de la pared abdominal. Objetivo: Reporte de un caso de un paciente con antecedente de múltiples cirugías abdominales que desarrolló un carcinoma escamoso sobre cicatriz de laparotomía previa. Pacientes y Métodos: Presentación de un de un paciente masculino de 61 años, con antecedente de laparotomía exploradora, que consultó por una tumoración, de 6 meses de evolución, vegetante sobre eventración de mediana suprainfraumbilical. Se realiza exéresis de lesión en bloque de pared con enterectomia, anastomosis primaria y eventroplastia con malla de reemplazo. Cursa internación prolongada y con mala evolución, falleciendo al 77 día postoperatorio. Conclusión: Los carcinomas de células escamosas que se desarrollan sobre lesiones cutáneas previas presentan una agresividad mayor a aquellos desarrollados espontáneamente, tienen alto porcentaje de recidiva y metástasis asociadas. Se propone abordajes quirúrgicos radicales para su tratamiento, aun asi presentando una morbimortalidad elevada

Background: Marjolin ulcers are skin malignancies that appear on skin affected by chronic ulcers, burns, scars, venous stasis or skin wounds. They are generally diagnosed through a biopsy and the most frequent type is the squamous cell carcinoma. There is little information on its development in existing abdominal surgical wounds, and there are even fewer cases reported in relation to its appearance upon an abdominal wall defect. Objective: To report a case of a patient with a history of multiple abdominal surgeries who developed a squamous cell carcinoma in an existing laparotomy scar in association with an incisional hernia. Patient and Methods: A 61-year-old male patient, with history of an exploratory laparotomy in 1986, presents with a 6-month-old vegetating tumor upon a supra-infraumbilical median eventration. An excision of the lesion that included the abdominal wall and an associated enterectomy, primary anastomosis, and eventroplasty with replacement mesh was performed. During his prolonged hospital stay, he underwent with many medical intercurrences and even an additional surgery was needed. Eventually, the patient dies 77 days after the surgery. Conclusion: Squamous cell carcinomas that develop in existing skin lesions tend to be more aggressive than those that develop spontaneously. They have a high percentage of recurrence and associated metastases. Radical surgical approaches are suggested for its treatment, although it has a high morbidity and mortality rate.

Cociente ganglionar como factor pronóstico de sobrevida. Recurrencia en carcinoma escamoso de cavidad oral / NODAL RATIO AS A PROGNOSTIC FACTOR OF SURVIVAL AND RECURRENCE IN ORAL SQUAMOUS CELL CARCINOMA

Antecedentes: El carcinoma escamoso de cavidad oral constituye una de las patologías de mayor frecuencia en cabeza y cuello. El tratamiento de elección es quirúrgico con altas tasas de control local. Sin embrago, se evidencian recidivas aún en etapas tempranas de la enfermedad, lo que lleva a la necesidad de identificar factores pronósticos confiables para mejorar la estadificación, tratamiento y seguimiento. El Cociente Ganglionar fue ratificado como herramienta pronóstica en otros tumores y validado en cavidad oral en un estudio multicéntrico dirigido por el Memorial Sloan Kettering Center de Nueva York. Objetivo: Validar en nuestro medio al Cociente ganglionar como factor pronóstico de sobrevida y recurrencia en carcinoma de cavidad oral. Lugar de aplicación: Hospital público de atención terciaria de tumores. Diseño: Cohorte Retrospectivo Institucional. Material y Métodos: Se recabó de manera retrospectiva información de historias clínicas, partes quirúrgicos e informes de anatomía patológica de un total de 92 pacientes. Se incluyeron aquellos con carcinoma escamoso de cavidad oral T 1-4 pN0-pN+ (pN1-2). Se calculó la sobrevida utilizando el método Kaplan-Meier y se realizó el análisis multivariado. Resultados: Un Cociente Ganglionar (CG.) mayor a 5% resultó estadísticamente significativo como factor pronóstico de sobrevida [HR 5,22(IC95% 1,86; 14;62) (p 0.002)] y recurrencia [HR 13.33 (IC95% 3.85; 46.16) No se evidenció diferencia pronóstica entre aquellos pacientes con vaciamientos pN0 y pN+ asociado a CG. menor a 5%. Pacientes pN1 y vaciamientos con recuento ganglionar total de 20 (1/20) podrían obtener un similar pronóstico al de pN0. Conclusiones: Fue posible ratificar al CG. como factor pronóstico y se plantea la posible utilidad del mismo en la indicación del tratamiento adyuvante

Background: Oral cavity squamous cell carcinoma is one of the most common pathologies in head and neck surgery. Surgery is the treatment of choice with high rates of locoregional control. However, recurrences are seen even in early stages of the disease. This explains the need of new prognostic factors to provide a better staging, treatment and follow up. Nodal Ratio has been validated as a prognostic tool in other tumors and in oral cavity in a multicentric study by Memorial Sloan Kettering Center of Nueva York. Objective: To validate the Nodal Ratio as a prognostic factor in terms of survival and recurrence in oral cavity carcinoma in our medium. Design: Institutional retrospective cohort. Setting: Tertiary Public Hospital for treatment of tumours. Population and Methods: We retrospectively review 92 patient´s information from clinic histories, surgical protocols and pathologic informs. Inclusion criteria were squamous cell histopathology, T1-4 and pN0-N+ (pN1-2) stage. We calculate survival with Kaplan-Meier method and multivariate analysis was done to determinate the independence value. Results: A Nodal Ratio higher than 5% was statistically significant as a prognostic factor of survival [HR 5,22(IC95% 1,86; 14;62) (p 0.002)] and recurrence [HR 13.33 (IC95% 3.85; 46.16) There was no prognostic difference between patients with pN0 dissections and those with pN+ dissections plus NR less than 5%. pN1 patients with nodal yields of 20 (1/20) or more could have the same forecast as a pN0. Conclusions: We were able to validate NR as a prognostic factor. We postulate the potential use in the indication of adjuvant therapy.

Carcinoma escamoso epicraneal metastásico con invasión parenquimatosa cerebral, a propósito de un caso / Metastatic epicranial squamous carcinoma with parenchymal brain invasion, apropos of a case

RESUMEN A nivel mundial se estiman que cada año se diagnostican aproximadamente 650 000 nuevos casos de cáncer escamoso de cabeza y cuello. Ocasionan 300 000 muertes y dos tercios de estos casos se originan en países en vías de desarrollo. Se presentó un caso de un paciente atendido en consulta a causa de crecimiento acelerado de la región frontotemporoparietal derecha, acompañado de sintomatología neurológica correspondiente a una afección funcional de los lóbulos parietal y temporal derecho. Se le realizó exámenes imagenológicos y biopsia por punción de la lesión, lo que arrojó un carcinoma escamoso como variedad histológica de la tumoración (AU).

ABSTRACT It is thought that around 650 000 new cases of head and neck squamous tumors are diagnosed in the world every year. They cause 300 000 deaths and two thirds of these cases are originated in developing countries. We presented the case of a patient who assisted the consultation due to the fast growth of the right frontotemporal parietal region, accompanied with neurological symptomatology corresponding to a functional disorder of the right parietal and temporal lobes. Imaging studies and a biopsy by lesion puncture were performed. It showed a squamous carcinoma as histological variant of the tumor (AU).

Perfil epidemiológico de pacientes com câncer de cabeça e pescoço em um hospital referência da região sul de Santa Catarina / Epidemiological perfil of patients with head and neck cancer in a reference hospital in the southern region of Santa Catarina

Realizou-se um estudo observacional, descritivo e retrospectivo através da coleta de dados de prontuários médicos com o propósito traçar um perfil epidemiológico dos pacientes diagnosticados com câncer de cabeça e pescoço em um hospital de referência no sul de Santa Catarina no período de janeiro de 2015 a dezembro de 2017. Foram analisados 161 prontuários, porém 153 preencheram os critérios de inclusão e compuseram a amostra final. Esses foram classificados em 3 grupos: carcinoma escamoso de cabeça e pescoço, tumores de nasofaringe e tumores de glândulas salivares. No primeiro grupo, a média de idade encontrada foi de 58,82 anos. Houve predomínio de homens (90,4%), cor da pele branca (94,1%) e pacientes com ensino fundamental incompleto (79,4%). 57,4% eram tabagistas e 28,7% etilistas. Maior parte (68%) chegou ao serviço em estágios avançados da doença (estágio III e IV). Nos cânceres de nasofaringe, a idade média foi de 57,88 anos. Predominou o sexo masculino (87,5%) e apenas 12,5% tinha história de tabagismo. 50% era do tipo carcinoma escamoso e 50% indiferenciado. Destes, 87,5% foram diagnosticados já no estágio IV. Sobre os cânceres de glândulas salivares, 62,67 anos foi a idade média. Nenhum paciente tinha história de tabagismo. 62,5% dos pacientes foram diagnosticados em estágio IVa e o tipo histológico mais frequente foi o adenóide cístico. Os resultados encontrados estão de acordo com a literatura. Destaque para a quantidade de pacientes diagnosticados em estágios avançados, sugerindo a necessidade do desenvolvimento de ações capazes de combater os fatores de risco e estratégias que permitam a detecção precoce dos tumores de cabeça e pescoço.

An observational, descriptive and retrospective study was conducted through the collection of data from medical records with the purpose of tracing an epidemiological profile of patients diagnosed with head and neck cancer at a referral hospital in southern Santa Catarina in the period of January 2015 to December 2017. 161 medical records were analyzed, but 153 met the inclusion criteria and made up the final sample. These were classified into 3 groups: squamous carcinoma of the head and neck, nasopharyngeal tumors and tumors of the salivary glands. In the first group, the average age found was 58.82 years. There was a predominance of men (90.4%), white skin color (94.1%) and patients with incomplete primary education (79.4%). 57.4% were smokers and 28.7% were alcoholics. Most (68%) arrived at the service in advanced stages of the disease (stages III and IV). In nasopharyngeal cancers, the mean age was 57.88 years. Male gender predominated (87.5%) and only 12.5% had a history of smoking. 50% were squamous carcinoma and 50% undifferentiated. Of these, 87.5% were diagnosed in stage IV. Regarding cancers of the salivary glands, 62.67 years was the average age. No patient had a history of smoking. 62.5% of patients were diagnosed with stage IVa and the most frequent histological type was cystic adenoid. The results found are in accordance with the literature. Highlight for the number of patients diagnosed in advanced stages, suggesting the need to develop actions capable of combating risk factors and strategies that allow the early detection of head and neck tumors.

Enfermedad de Bowen de localización inusual / Bowen's disease of unusual location

La enfermedad de Bowen es un carcinoma de células escamosas intraepidérmico con potencial invasor que se ve con mayor frecuencia en mayores de 60 años. Se presenta usualmente como una placa eritematosa de crecimiento lento en zonas fotoexpuestas. Presentamos el caso de una mujer de 65 años con carcinoma escamoso in situ variedad pagetoide localizado en la mama izquierda en el cual fue determinante la inmunohistoquímica para realizar el diagnóstico final.

Profile of women with cervical cancer attended for treatment in oncology center / Perfil de mulheres com câncer de colo do útero atendidas para tratamento em centro de oncologia

Abstract Objectives: to evaluate the sociodemographic, clinical, histopathological, cytopathological and microbiological profile of women with cervical cancer treated at Oncology Center in Pernambuco, located in the city of Caruaru-PE. Methods: a retrospective study was carried out to evaluate the medical records of women with cervical cancer treated for radiotherapy and/or chemotherapy between January 2014 and December 2016. For the analysis of variables, the absolute and relative frequencies were calculated. Results: there was a predominance of cases in the age range between 40 and 59 years (45.37%), non-white race/color (91.75%) and incomplete primary education (44.32%). Squamous carcinoma was present in 85.19% of the cases, with a moderately differentiated histological grade being the most common (53.41%). Most women underwent radiotherapy and associated chemotherapy (72.72%) and had 3 or more pregnancies before diagnosis (73.44%). Cytopathology has more frequently identified high-grade squamous intraepithelial lesion (HSIL) cases (45.83%) and cocci and/or bacilli (66.67%) were the most evident microorganisms. Conclusions: the results showed that the perimenopause age, low educational level, multiparity, cytopathologic result of HSIL and histopathological examination evidencing moderately differentiated squamous cell carcinoma were among the characteristics most related to cervical cancer in the population studied.

Resumo Objetivos: avaliar o perfil sociodemográfico, clínico, histopatológico, citopatológico e microbiológico de mulheres com câncer de colo do útero atendidas em Centro de Oncologia Pernambucano. Métodos: estudo retrospectivo, que avaliou os prontuários de mulheres com câncer de colo do útero atendidas para tratamento radioterápico e/ou quimioterápico entre janeiro de 2014 e dezembro de 2016. Para a análise das variáveis foram calculadas as frequências absolutas e relativas. Resultados: houve predominância de casos na faixa etária entre 40 a 59 anos (45,37%), de raça/cor não branca (91,75%) e com até o ensino fundamental incompleto (44,32%). O carcinoma escamoso esteve presente em 85,19% dos casos, sendo o grau histológico moderadamente diferenciado o mais comum (53,41%). A maioria das mulheres realizaram radioterapia e quimioterapia associadas (72,72%) e apresentaram 3 gestações ou mais antes do diagnóstico (73,44%). A citopatologia identificou, com maior frequência, casos de high-grade squamous intraepithelial lesion(HSIL) (45,83%) e cocos e/ou bacilos (66,67%) foram os microrganismos mais evidentes. Conclusões: os resultados revelaram que a idade perimenopausa, baixo grau de escolaridade, multiparidade, resultado citopatológico de HSIL e exame histopatológico evidenciando carcinoma escamoso moderadamente diferenciado, estavam entre as características mais relacionadas ao câncer de colo do útero na população estudada.

Carcinoma escamoso de vulva / Vulvar squamous carcinoma

El cáncer de vulva es una neoplasia relativamente rara, supone 5 por ciento de todos los cánceres ginecológicos. Su etiología, en general, se desconoce, pero existen pruebas que categorizan el virus del papiloma humano como un factor causal. En Cuba representa menos de 1 por ciento de todos los tumores malignos de la mujer, con su máxima aparición en la pos menopausia. Presentamos un caso de carcinoma escamoso de vulva diagnosticado en la atención primaria de salud. Se trata de una fémina de 65 años de edad, mestiza, fumadora inveterada, primeras relaciones sexuales a los 20 años, múltiples parejas sexuales, la mayoría desprotegidas, citología realizada en el año 2014 negativa, quien acudió a su consultorio, perteneciente al Policlínico Docente Efraín Mayor Amaro, del Cotorro, por presentar aumento de volumen en sus genitales, en ocasiones le producía prurito. Al examen físico se constató lesión verrugosa en el labio mayor derecho de aproximadamente 4 cm de diámetro, de contornos irregulares, no dolorosa a la palpación. Se interconsulta con Ginecología donde se indica exámenes complementarios, que demostraron en la citología actual, una displasia leve, NIC I, HPV. En consulta de Patología de cuello se realiza biopsia por ponche que se informa como: Carcinoma escamoso moderadamente diferenciado verrugoso. Posteriormente fue remitida a consulta de oncología para tratamiento quirúrgico, siguiendo los protocolos marcado por el comité oncológico de la Federación Internacional de Ginecólogos y Obstetras (FIGO). Se reafirma que el diagnóstico temprano es importante, debiéndose realizar mediante evaluación clínico e histopatológica, garantizando su tratamiento oportuno(AU)

Vulvar cancer is a relatively rare neoplasm, accounting for 5 percent of all gynecological cancers. The etiology is unknown, but there are tests that categorize by preference the human papillomavirus (HPV) as a causal factor. In Cuba, it represents less than 1 percent of all malignant tumors in women, and the maximum appearance in post menopause. We present the case of a patient over 65 years of age, mestizo, and incorrigible smoker. She had her first sexual intercourses at age 20, most of them unprotected, she had multiple sexual partners. The cytology performed in 2014 was negative. She came to consultation due to an increase in the volume of her genitals, which sometimes caused itching. In pathology consultation, punch biopsy is performed, which is reported as moderately differentiated verrucous squamous carcinoma. She was then taken on an Oncology consult for surgical treatment, following the protocols marked by the oncologic committee of the International Federation of Gynecologists and Obstetrics (FIGO). Early diagnosis is important and should be carried out through clinical and histopathologically evaluation to ensure timely treatment(AU)

Carcinoma escamoso de cavidad oral en paciente menor de edad / Oral squamous cell carcinoma in an underage patient

El objetivo de este caso es profundizar en el conocimiento del cáncer de lengua en pacientes jóvenes. Se trata de un caso clínico: Mujer de 17 años sin antecedentes ni hábitos tóxicos, que acude por presentar tumoración en hemilengua izquierda con biopsia de carcinoma escamoso. En TAC: Lesión en hemilengua izquierda que afecta al suelo de la boca. Adenopatías bilaterales. Estadío IVA. Se decide quimioterapia de inducción seguido de quimioradioterapia. Presentó recidiva tras 5 meses de seguimiento, y se realizó glosectomía parcial. Tras 12 meses libre de enfermedad presentó nueva recidiva local que se intervino quirúrgicamente. Actualmente en seguimiento y sin signos de enfermedad. Existen estudios que indican que la prevalencia del cáncer de cabeza y cuello está aumentando en pacientes jóvenes; comportándose de forma diferente entre unos grupos de edad y otros. Concluimos que los factores epidemiológicos, genéticos, etiológicos y clinicopatológicos de los pacientes jóvenes con cáncer de cabeza y cuello sugieren una divergencia biológica frente a lo que ocurre con dichos cánceres en pacientes añosos. La mejora del conocimiento de la biología molecular es necesaria para establecer el éxito en la prevención y el tratamiento de dichos pacientes.

To delve into the knowledge of tongue cancer in young patients. Case We presented a 17 years-old female, without tobacco and alcohol exposure, referred to Oral and Maxillofacial department with a squamous cell carcinoma in the tongue with bilateral cervical metastasis. We decided, in a multidisciplinary team, to treat her with chemotherapy followed by chemoradiotherapy. She had two local recurrences 5 and 12 months after the treatment which we treated with surgery both. Afher that, we follow her every month and she is without recurrences. Several reports suggest increasing incidence trends of head and neck cancer in young patients, disproportional to the patients above 45 years old. Moreover, the majority of young non-smoking non-drinking head and neck cancer patients is female. This disparity suggests that the pathogenesis of head and neck cancer in young patients differs from head and neck cancer development in old patients. Conclusion: The unique epidemiologic, genetic, etiologic, and clinicopatho- logic characteristics of young-onset HNSCC suggests a divergent biology from HNSCC occurring in older patients. Improved definition of this biology is needed to establish successful preventive and treatment de intensification efforts.

Cáncer de laringe: serie de casos en 6 años en el Complejo Asistencial Doctor Sótero del Río / Laryngeal cancer: report of 6 years cases in Complejo Asistencial Doctor Sótero del Río

Introducción: El cáncer de laringe es la segunda causa de muerte en otorrinolaringología. Su tratamiento en estadios avanzados es agresivo y controversial. Objetivo: Reportar los datos de pacientes atendidos en el Complejo Asistencial Doctor Sótero del Río entre los años 2005-2011. Material y método: Análisis retrospectivo descriptivo. Resultados: Total de 38 pacientes, 30 (79%) hombres, mediana de edad 66 años. Los principales motivos de consulta fueron dificultad respiratoria en 18 pacientes (47%) y disfonía en 14 (37%). Se realizó estudio y etapificación con nasofibroscopía y tomografía computarizada. El 71% se presentó en estadio avanzado, de ellos, el 30% recibió quimiorradioterapia exclusiva. La sobrevida global a 2 y 5 años fue de 56% y 42% respectivamente en estadio avanzado y de 100% y 71% respectivamente en estadio precoz. Discusión: El cáncer de laringe es una enfermedad con sobrevida baja a pesar de tratamientos agresivos. Se han planteado alternativas al tratamiento estándar como terapia conservadora con quimiorradioterapia exclusiva o microcirugía láser transoral. Conclusiones: La epidemiología del cáncer laríngeo se ha mantenido relativamente estable y la clasificación TNM sigue siendo fundamental para el tratamiento, especialmente en contexto de nuevas alternativas de manejo de cáncer avanzado. Se espera evaluar estas terapias.

Introduction: Laryngeal cancer is the second cause of death in otolaryngology. Its treatment in advanced stage is aggressive and controversial. Aim: To report data from patients treated in Complejo Asistencial Doctor Sótero del Río in the period between 2005-2011. Material and method: Descriptive retrospective analysis. Results: 38 patients in total, 30 (79%) men, median age 66 years. The main symptoms were breathing difficulty in 18 patients (47%) and dysphonia in 14 (37%). Every patient completed study and disease staging with nasofibroscopy and computed tomography. 71% presented in advanced stage, among them, 30% received exclusive chemoradiotherapy. Overall survival for 2 and 5-year in advanced stage was 56% and 42% respectively; and 100% and 71% in early stage. Discussion: Advanced laryngeal cancer has low survival rate in spite of aggressive treatments. Alternatives to standard care have been proposed, such as conservative therapy with exclusive chemoradiotherapy or transoral laser microsurgery. Conclusions: Laryngeal cancer's epidemiology remains relatively unchanged and TNM classification still remains fundamental for treatment, specially in the context of new therapeutic alternatives for advanced cancer. Evaluation of these therapies is expected.

Importancia de la epidemiología en cáncer laríngeo: incidencia y mortalidad por carcinoma escamoso de laringe / Importance of epidemiology in laryngeal cancer: incidence and mortality due to squamous cell carcinoma of the larynx

Actualmente se realiza un diagnóstico anual de 650.000 nuevos casos de carcinoma escamoso de cabeza y cuello en el mundo, siendo el carcinoma escamoso de laringe una patología neoplásica que compete al otorrinolaringólogo. La incidencia mundial del cáncer escamoso de laringe se estima en 3,9 por cada 100.000 habitantes con una mortalidad general de 2,0 por cada 100.000 habitantes. En Chile el registro de cáncer se realiza en base a los cinco registros poblacionales de cáncer que existen. No se tienen datos exactos respecto a incidencia y mortalidad por carcinoma escamoso de laringe, siendo la estimación de la incidencia de 1,2 casos por cada 100.000 habitantes y la estimación de mortalidad ajustada por edad de 0,7 casos por cada 100.000 habitantes. Se han descrito diversos factores de riesgo ambientales y estilos de vida para este cáncer, por lo tanto, las estrategias de prevención primaria en salud son claves a la hora de generar un impacto en la incidencia del carcinoma escamoso de laringe.

The annual diagnosis of head and neck squamous cell carcinoma is 650,000 new cases. The laryngeal carcinoma is a malignant disease that should include an otolaryngologist in its evaluation. The global incidence of laryngeal carcinoma is estimated at 3.9 per 100,000 inhabitants with an overall mortality rate of 2.0 per 100,000 inhabitants. In Chile the cancer registry is based on the five population cancer registries that exist. There is no accurate data on incidence and mortality from laryngeal carcinoma, being an estimated incidence of 1.2 cases per 100,000 inhabitants and an age-adjusted mortality of 0.7 cases per 100.00 inhabitants. There have been described various environmental risk factors and lifestyles for this cancer, therefore, primary prevention strategies are key to generate an impact on the incidence of larynx carcinoma.

Anal canal squamous carcinoma / Carcinoma epidermóide do canal anal

ABSTRACT Background: Anal canal carcinoma is a rare neoplasm, representing 2% of the digestive tumors, and the most common is squamous cell carcinoma, with an increasing incidence. Objective: The study aims to elucidate the pathogenesis of an increasingly prevalent disease, as well as to update treatment and prognosis. Methods: A literature search in Pubmed database, including articles from 2005 to 2015 and cross-research articles with the initial research. Results: Several studies prove the role of HPV as a major risk factor in the development of squamous cell carcinoma of anal canal, as well as a greater prevalence of this neoplasia in HIV-positive people and in those who practice receptive anal intercourse. In the last two decades chemoradiotherapy remains the treatment of choice, and abdominoperineal resection is reserved for those cases of treatment failure or recurrence. Evidence advances in order to adapt the treatment to each patient, taking into account individual prognostic factors and biological tumor characteristics. Conclusions: Squamous cell carcinoma of the anal canal is a neoplasm associated with HPV; therefore, screening and vaccination programs of male individuals, by way of prevention, should be started. Many studies are needed in order to achieve development in the treatment as well as in the evaluation of the biological characteristics of the tumor.

RESUMO Introdução: O carcinoma do canal anal é uma neoplasia rara, representando 2% dos tumores digestivos, sendo o epidermóide o mais comum com uma incidência crescente. Objetivo: Este estudo pretende elucidar sobre a etiopatogenia desta patologia cada vez mais prevalente, assim como atualizar sobre o tratamento e prognóstico. Métodos: Pesquisa bibliográfica na base de dados Pubmed, incluindo artigos de 2005 a 2015, assim como artigos de pesquisa cruzada com os artigos iniciais. Resultados: Diversos estudos provam o papel do HPV como um fator de risco major no desenvolvimento de carcinoma epidermóide do canal, assim como uma maior prevalência desta neoplasia na população HIV positiva e nos que praticam sexo anal recetivo. O tratamento continua a ser desde há duas décadas a quimioradioterapia, reservando a resseção abdominoperineal para casos de falência do tratamento ou recorrência. A evidência avança no sentido de adequar o tratamento a cada doente, tendo em conta fatores prognósticos individuais e as características biológicas do tumor. Conclusões: O carcinoma epidermóide do canal anal é uma neoplasia associada ao HPV, logo deveria iniciar-se programas de rastreio e vacinar o sexo masculino como prevenção. Muitos estudos são necessários para evoluir no tratamento, assim como na avaliação das características biológicas do tumor.

Carcinoma escamoso primario de órbita / Primary orbital squamous cell carcinoma

El carcinoma escamoso primario de órbita es una entidad poco frecuente. Hay escasa literatura publicada al respecto. Presentamos un caso de carcinoma escamoso primario de los tejidos blandos de la órbita. La resección quirúrgica ofrecía el mejor tratamiento para esta paciente. Se realizó un abordaje cráneo-facial y se logró la resección completa de la lesión. La paciente recibió radioterapia adyuvante debido a la proximidad de la lesión a los márgenes quirúrgicos. El tratamiento quirúrgico es factible y debe ser considerado como parte del arsenal del cirujano. Sin embargo, las decisiones terapéuticas deben tomarse teniendo en cuenta las particularidades de cada caso.

Primary orbital squamous cell carcinoma is a rare entity. There is little published literature. We report a case of primary squamous cell carcinoma of the orbital soft tissues. Surgical resection offered the best treatment for the patient. Complete resection of the lesion was achieved. The patient received adjuvant radiotherapy due to the proximity of the lesion to the surgical margins. Surgical treatment is feasible and should be considered as part of the surgeon´s arsenal. However, therapeutic decisions must be made on a case-by-case basis.

Carcinoma escamoso de conducto auditivo externo: reporte de 3 casos / Squamous cell carcinoma of the external auditory canal: report of three cases

El carcinoma escamoso de conducto auditivo externo es poco frecuente. La sintomatología puede semejar una otitis externa u otitis media crónica, lo que puede retrasar el diagnóstico. La falta de un sistema de clasificación y el número limitados de casos hace difícil la elaboración de guías de tratamiento. Se describe una serie de casos de esta neoplasia, asf como una revisión de la literatura actual.

Squamous cell carcinoma of the external auditory canal is rare. The symptoms may resemble an external otitis or chronic otitis media, which can delay diagnosis. The lack of a classification system and the limited number of cases makes it difficult the development of treatment guidelines. We present a case series of this neoplasia, as well as a review of the literature.

Diagnóstico histopatológico de cáncer bucal en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" / Histopathological diagnosis of the oral cancer in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital

Se efectuó una investigación descriptiva y retrospectiva en el Departamento de Anatomía Patológica del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, con vistas a determinar la incidencia del cáncer bucal diagnosticado histopatológicamente, para lo cual se revisaron las fichas de las biopsias realizadas desde el año 2008 al 2013, y se seleccionaron las 28 con dicho diagnóstico. El grupo etario más afectado fue el de 59-69 años (50,0 %), aunque 8 pacientes tenían menos de 59 años de edad (28,5 %); la localización anatómica predominante fue la lengua, seguida del paladar (57,1 % para ambos casos); el tipo histológico más diagnosticado resultó el carcinoma escamoso (78,5 %) y el hábito tóxico más frecuente fue el de fumar. Pudo concluirse que el cáncer de la boca presentó una elevada incidencia en esta institución hospitalaria, por lo que deben extremarse los cuidados en la aplicación del Programa de Detección Precoz de Cáncer Bucal en la atención primaria de salud.

A descriptive and retrospective investigation was carried out in the Pathology Department from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, with the aim of determining the incidence of the histopathologically diagnosed oral cancer, for which the records of the biopsies carried out from 2008 to 2013 were reviewed, and the 28 with this diagnosis were selected. The most affected age group was the 59-69 group (50.0%), although 8 patients had less than 59 years (28.5%); the predominant anatomical localization was the tongue, followed by the palate (57.1% for both cases); the histological type most diagnosed was the squamous cell carcinoma (78.5%) and the most frequent toxic habit was smoking. It could be concluded that the mouth cancer had a high incidence in this hospital institution, so that care should be extreme in the implementation of the Program for early Detection of oral Cancer in the primary health care.

Reconstrucción palpebral inferior después de la escisión de tumores malignos / Lower eyelid reconstruction after excision of malignancies

Se presentan 4 casos clínicos de pacientes de 46-76 años con carcinomas basocelular y escamoso de párpado inferior, diagnosticados en la consulta oftalmológica del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso". A los afectados se le realizó tarsectomía parcial o total con reconstrucción palpebral mediante colgajos miocutáneos en islas de área cigomática y músculo nasal. Los resultados tanto funcionales como estéticos fueron óptimos y se corroboró la efectividad de los colgajos antes citados.

Four case reports of patients of 46-76 years with squamous-cell carcinoma and basal-cell epithelioma of lower eyelid was described, diagnosed in the ophthalmology department of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital. In those affected a partial or total tarsectomy with eyelid reconstruction by means of island myocutaneous flaps of zygomatic area and nasal muscle was performed. The functional and aesthetic results were optimal and the effectiveness of these flaps was confirmed.

Carcinoma de células escamosas con invasión orbitaria / Squamous cll carrcinoma with orbital extension

El carcinoma de células escamosas (CE) es una patología rara, su incidencia es del 0,13 a 1.9 casos por 100.000 habitantes, que acontece con más frecuencia en varones entre la quinta y séptima década de la vida. Presentamos el caso de una paciente de 42 años con CE con invasión a orbita de ojo izquierdo que fue sometida a exenteraciòn.

The carcinoma ofscaly cells (CE) it is a strange pathology, their incidence it is from the 0,13 to 1.9 cases for 100.000 inhabitants that it happens with more frequency in males between the fifth and seventh decade of the life. We present the case of a 42 year-old patient with CE with invasion to it orbits from left eye that was subjected to exenteracion.

Early detection and treatment of squamous cell lung cancer / Diagnóstico precoce e tratamento do carcinoma escamoso de pulmão

In this review, we discuss the detection, staging, and treatment of early-stage squamous cell lung cancer, with a focus on bronchoscopic techniques, including electrocauterization, argon plasma coagulation, cryotherapy, neodymium: yttriumaluminum-garnet laser therapy, photodynamic therapy, and intraluminal brachytherapy.The cure rate achieved with bronchoscopic techniques is 43-97%. Most bronchoscopic strategies are less morbid and less toxic than is non-bronchoscopic radiation therapy. Success depends on the application of stringent selection criteria forappropriate tumors, smaller tumors responding better. In some cases, electrocauterization, argon plasma coagulation, and cryotherapy can be conducted safely in an outpatient setting. There is sufficient technology available for the detection and treatment of early-stage squamous cell lung cancer. The greatest challenge is to determine whether early detection and treatment improves survival in high-risk populations and is cost-effective.

Neste artigo de revisão, discutimos os métodos para detecção, estadiamento e tratamento do carcinoma epidermoideprecoce com foco em técnicas broncoscópicas, como eletrocautério, coagulação com plasma de argônio, crioterapia, laser neodímio:ítrio-alumínio-granada, terapia fotodinâmica e braquiterapia intraluminal. A taxa de cura com as técnicas broncoscópicas é 43-97%. A maioria das estratégias broncoscópicas apresenta menor morbidade e toxicidade que a radioterapia. O sucesso depende da aplicação rigorosa de critérios de seleção de acordo com o tumor, sendo que aqueles menores apresentam melhor resposta. Em alguns casos, o eletrocautério, a coagulação com plasmade argônio e a crioterapia podem ser utilizados ambulatorialmente com segurança. Há suficiente tecnologia disponível para a detecção e tratamento precoce do câncer de pulmão epidermoide. O maior desafio é determinar se a detecção e o tratamento precoces melhoram a sobrevida em coortes de alto risco e se tal abordagem é custo-efetiva.