ABSTRACT
Resumen Los tumores malignos de glándulas salivales (TMGS) constituyen un grupo infrecuente de cánceres de una gran variedad histológica. Dentro de las neoplasias de estirpe epitelial encontramos al carcinoma de células acinares (CCA), que representa entre un 6%-10% de todos los TMGS. No posee patrones clínicos ni radiológicos específicos, pero comparte características comunes con otros TMGS que serán discutidas a lo largo del reporte. Cabe destacar que en términos generales es un cáncer de bajo grado y poco recidivante, por lo que un tratamiento oportuno y un seguimiento estricto mejoran el pronóstico para este tipo de pacientes. Su diagnóstico se establece con evidencia histopatológica que confirme la presencia de diferenciación epitelial de tipo acinar. El tratamiento consiste en la exéresis tumoral con márgenes libres por parotidectomía suprafacial o total, asociado a vaciamiento cervical si se detecta compromiso nodal. Adicionalmente, se debe sugerir terapia adyuvante ante la presencia de un factor de mal pronóstico. Se presenta un caso y se realiza revisión de literatura.
Abstract Malignant salivary gland tumors (TMGS) constitute an infrequent group of cancers of a wide histological variety. Within the epithelial lineage neoplasms, we find acinar cell carcinoma that represent between 6%-10% of all TMGS. It does not have specific clinical or radiological patterns, but it shares common characteristics with other TMGS that will be discussed throughout the report. It should be noted that in general terms it is a low-grade cancer with low recurrence rates, so timely treatment and strict follow-up improve the prognosis for this type of patient. Its diagnosis is established with histopathological evidence that confirms the presence of acinar-type epithelial differentiation. Treatment consists of tumor excision with free margins by suprafacial or total parotidectomy, associated with cervical lymph node dissection if nodal locoregional metastasis is detected. Additionally, adjuvant therapy should be suggested in the presence of a poor prognostic factor. A case is presented and a literature review is carried out.
Subject(s)
Humans , Male , Aged , Parotid Neoplasms/diagnosis , Carcinoma, Acinar Cell/diagnosis , Prognosis , Parotid Neoplasms/therapy , Tomography, X-Ray Computed/methods , Carcinoma, Acinar Cell/therapyABSTRACT
ABSTRACT: Multiple salivary gland tumors represent an unusual event characterized by the development of composite lesions originated from minor or major salivary glands. These neoplasms can be categorized into three perspectives: Histologic type, time of appearance and topographic distribution. We report an unusual case of a 73-year-old black man with an acinic cell carcinoma (ACC) of the oral mucosa discovered incidentally during surgical removal of an adjacent mucocele. Approximately one year after the first consultation, the patient was seen at the local cancer reference center with a third lesion that was diagnosed as an adenoid cystic carcinoma (AdCC) of the upper lip. The patient underwent surgical reconstruction of the treated areas and has been free of the disease for the past year. To our knowledge, the combination of ACC and AdCC in intraoral sites has not been reported in the literature.
RESUMEN: Los tumores de glándulas salivales múltiples representan un evento inusual caracterizado por el desarrollo de lesiones compuestas, originadas en glándulas salivales menores o mayores. Estos neoplasmas se pueden categorizar en tres perspectivas: tipo histológico, tiempo de aparición y distribución topográfica. Reportamos un caso inusual de un hombre negro de 73 años con un carcinoma de célula acínica (ACC) de la mucosa oral descubierta incidentalmente durante la extirpación quirúrgica de un mucocele adyacente. Aproximadamente un año después de la primera consulta, el paciente se presentó en el centro de referencia del cáncer local con una tercera lesión que fue diagnosticada como carcinoma adenoide quístico (AdCC) del labio superior. El paciente se sometió a la reconstrucción quirúrgica de las áreas tratadas y durante el último año no ha presentado recurrencia de la enfermedad. De acuerdo a nuestro conocimiento la combinación de ACC y AdCC en sitios intraorales no se ha informado en la literatura.
Subject(s)
Humans , Male , Aged , Salivary Gland Neoplasms/pathology , Neoplasms, Second Primary/mortality , Carcinoma, Acinar Cell/pathology , Carcinoma, Adenoid Cystic/surgery , Radiotherapy , Biopsy , Salivary Gland Neoplasms/therapy , Carcinoma, Acinar Cell/therapy , LipABSTRACT
Carcinomatous encephalitis is a rare entity, originally described by Madow and Alpers in 1951, which is characterized by tumoral spreading perivascular, without mass effect. Clinical manifestations such as hemiparesis, seizures, ataxia, speech difficulties, cerebrospinal fluid findings as well as computed tomography are nonspecific. This leads the physician to pursue more frequent diseases that could explain those manifestations - toxic, metabolic, and/or infectious encephalopathy. A magnetic resonance imaging (MRI) with gadolinium, the method of choice, presumes the diagnosis. Previous reports of this unusual form of metastatic disease have described patients with prior diagnosis of pulmonary adenocarcinoma. We present the case of carcinomatous encephalitis in a 76-years-old woman as the primary manifestation of occult pulmonary adenocarcinoma with its clinical, imaging, and anatomopathological findings.
A "encefalite" carcinomatosa é entidade rara, descrita originalmente por Madow e Alpers em 1951 e caracterizada pela disseminação tumoral perivascular, sem causar efeito de massa. As manifestações clínicas como hemiparesia, convulsões, ataxia, alterações de fala, os achados do líquido cefalorraquidiano e da tomografia computadorizada de crânio são inespecíficos, o que faz buscar outras causas mais freqüentes que justifiquem o quadro -encefalopatia tóxica, metabólica e/ou infecciosa. A ressonância magnética com gadolínio é o exame de eleição, frente à suspeita clínica. Todos os casos de "encefalite" carcinomatosa foram relatados em pacientes com diagnóstico prévio de adenocarcinoma de pulmão. Nesse sentido. Apresentamos caso de encefalite carcinomatosa, em mulher de 76 anos como manifestação primária de adenocarcinoma de pulmão oculto, com seus aspectos clínicos, de imagem e anatomopatológicos.
Subject(s)
Aged , Female , Humans , Brain Neoplasms/secondary , Carcinoma, Acinar Cell/secondary , Lung Neoplasms/pathology , Brain Neoplasms/diagnosis , Brain Neoplasms/therapy , Carcinoma, Acinar Cell/diagnosis , Carcinoma, Acinar Cell/therapy , Lung Neoplasms/therapy , Magnetic Resonance ImagingABSTRACT
Se presentan dos pacientes hermanos con tumoraciones parotídeas, que fueron operados en el Hospital Provincial Docente Dr. Antonio Luaces Iraola. A los mismos se les realizó parotidectomía total conservadora, previa biopsia por congelación, siendo el resultado histopatológico Carcinoma de Células Acinares. Aproximadamente a los cinco años, ambos son reintervenidos por presentar tumoraciones parotídeas en el lado opuesto, por lo que se sometieron a una nueva parotidectomía total conservadora; el resultado histopatológico fue igual al anterior. No hubo complicaciones postoperatorias y la evolución a largo plazo fue favorable.
Two siblings patients with malignant tumors of the parotid are presented, both of them underwent conservative complete parotidectomy with previous biopsy by freezing at the Dr. Antonio Luaces Iraola provincial teaching hospital . The histopathological result revealed acinic cell carcinoma. At roughly five years later, both of them underwent surgery again for displaying tumors in the opposite side of the parotid , for this reason they underwent a new conservative complete parotidectomy; the histopathological result was the same as the previous one. No postoperative complications were encountered and long term evolution was favorable.