Líquen Plano Oral e seu Potencial de Malignização / Lichen Planus and its potencial for malignancy

Objetivos: Instruir e orientar ao cirurgião dentista e demais profissionais de saúde a importância da detecção e rastreio precoce de lesões pré-malignas. Revisão de Literatura: O Líquen Plano Oral é uma condição dermatológica crônica, de origem auto-imune, relativamente comum na população, que atinge o epitélio de mucosa e pele, sendo considerada, pela Organização Mundial de Saúde (OMS), uma desordem potencialmente maligna quando associado a áreas de ulceração. A revisão de literatura foi realizada nas bases de dados PubMed e Lilacs. Buscamos investigar o potencial de malignização do Líquen Plano Oral associado a condições erosivas, analisando o processo de carcinogênese no processo inflamatório. Conclusão: Conclui-se que o objeto de estudo ainda é um assunto pouco explorado pela literatura, porém há indícios etiopatológicos que enfatizam o processo de malignização oriundo de uma lesão pré-maligna como o Líquen Plano Oral. Além disso, enfatizamos a importância do diagnóstico precoce das lesões estomatognáticas, para que assim possamos aumentar as chances de cura do paciente.(AU)

Objectives: To instruct and guide dentists and other health professionals on the importance of early detection and screening of pre-malignant lesions. Literature Review: Oral Lichen Planus is a chronic dermatological condition, of autoimmune origin, relatively common in the population, which affects the epithelium of the mucosa and skin, being considered, by the World Health Organization (WHO), a potentially fatal disorder. malignant when associated with areas of ulceration. A literature review was performed on the PubMed and Lilacs databases. We sought to investigate the potential for malignancy of Oral Lichen Planus associated with erosive conditions, analyzing the process of carcinogenesis in the inflammatory process. Conclusion: It is concluded that the object of study is still a subject little explored in the literature, but there are etiopathological accusations that emphasize the process of malignancy arising from a pre-malignant lesion such as Oral Lichen Planus. In addition, we emphasize the importance of early diagnosis of stomatognathic lesions, so that we can increase the patient's chances of cure.(AU)

Aggressive parotid gland and neck metastasis caused by cutaneous squamous cell carcinoma of the scalp: a case report / Metástasis agresiva de glándula parótida y cuello causada por carcinoma cutáneo de células escamosas decuero cabelludo: reporte de un caso

Introduction: The head and neck are frequent sites for the development of cutaneous cancer and squamous cell carcinoma of the skin (SCC), one of the more frequent malignant non-melanoma skin neoplasms in Chile (436 per 100,000 inhabitants). Between 5-10% skin SCC progresses aggressively generating metastasis to parotid and cervical lymph nodes. Case Report: A 82 years old male, presents painful increased volume lesion in the mandibular area. He has a history of chronic arterial hypertension, acute renal failure, SCC of the scalp, extra-pulmonary tuberculosis, chronic sun exposure and smoking. Extraoral examination showed a 4 cm lesion in the posterior third of the mandibular branch, with undefined edges, a firm consistency and painful on palpation. Intraorally, erythematous mucosa is observed, as well as lack of lubrication, tenderness and cortical bone expansion. Incisional biopsy is performed, imaging and histological exams are requested. The results indicate the presence of SCC, and therefore referral to secondary care. Many risk factors are associated with SCC development, with ultraviolet radiation the most relevant in this case, favoring its appearance on the scalp. The probability of metastasis is low, but when it happens, the majority of cases that started in the scalp, disseminate to the parotid and cervical region. Conclusion: The SCC has a good prognosis. However, there are antecedents, such as size and location, that must alert the professional to perform the monitoring, early screening, control of metastatic nodes in maxillofacial area.

Introducción: La cabeza y el cuello son sitios frecuentes de desarrollo de cáncer cutáneo y el carcinoma epidermoide de piel (CEC) es una de las neoplasias malignas sin melanoma más frecuentes en Chile (436 por 100.000 habitantes). Entre el 5% y el 10% del CCE cutáneo progresa de forma agresiva y genera metástasis en los ganglios linfáticos parótidos y cervicales. Reporte de Caso: Varón de 82 años, presenta lesión dolorosa de aumento de volumen en zona mandibular. Tiene antecedentes de hipertensión arterial crónica, insuficiencia renal aguda, CCE del cuero cabelludo, tuberculosis extrapulmonar, exposición crónica al sol y tabaquismo. El examen extraoral mostró una lesión de 4 cm en el tercio posterior de la rama mandibular, con bordes indefinidos, consistencia firme y dolorosa a la palpación. Intraoralmente se observa mucosa eritematosa, así como falta de lubricación, dolor a la palpación y expansión del hueso cortical. Se realiza biopsia incisional, se solicitan exámenes de imagen e histológicos. Los resultados indican la presencia de CCE y, por tanto, derivación a atención secundaria. Son muchos los factores de riesgo asociados al desarrollo de CEC, siendo la radiación ultravioleta la más relevante en este caso, favoreciendo su aparición en el cuero cabelludo. La probabilidad de metástasis es baja, pero cuando ocurre, la mayoría de los casos que comenzaron en el cuero cabelludo se diseminan a la región parotídea y cervical. Conclusión: El SCC tiene un buen pronóstico. Sin embargo, existen antecedentes, como tamaño y ubicación, que deben alertar al profesional para realizar el seguimiento, cribado precoz, control de ganglios metastásicos en zona maxilofacial.

Caracterización epidemiológica, clínica e histopatológica de los tumores malignos de cérvix en las pacientes sometidas a histerectomía radical tipo Wertheim-Meigs que acuden al servicio de Ginecología y Obstetricia del Hospital General San Juan de Dios, de Guatemala (enero 2017 a diciembre del 2018) / Epidemiological, clinical and histopathological characterization of malignant tumors of the cervix in patients undergoing Wertheim-Meigs radical hysterectomy who attend the Gynecology and Obstetrics service of the San Juan de Dios General Hospital, Guatemala (January 2017 to December 2018)

Los tumores malignos de cérvix continúan siendo un problema de salud pública para nuestro país, es por ello que se consideró de importancia realizar este estudio. Se estudiaron las características clínicas más frecuentes encontradas en las pacientes sometidas dentro de los cuales encontramos como principal motivo de consulta el dolor pélvico con un 86.75%, seguido del sangrado con un 84.34% finalizando con la leucorrea con el 79.52%. En cuanto a la clasificación de los tumores malignos se comprobó que la mayoría de las pacientes presentaron el estadio CaCu IB1 con el 91.57% seguido del CaCu IA1 con el 6.02% finalizando con el CaCu IB2 con el 2.41%. Así mismo, se pudo determinar que los tumores malignos de cérvix más frecuentes en las pacientes estudiadas fue el carcinoma epitelial, seguido del adenocarcinoma de cérvix, siendo su histopatología más encontrada el carcinoma epidermoide no queratinizante de células grandes con el 53.01%. (AU)

Uterine Cervical Cancer continues to be one of the main public health problems in Guatemala, thus being important to do this type of research. The most frequent clinical characteristics found in the present study were pelvic pain (86.75%) followed by bleeding in 84.34% and vaginal discharge in 79.52%. Most of the patients were classified as Stage IB1 (91.57%) followed by Stage IA1(6/02%) and Stage IB2 (2.41%). The most frequent Histologic Type was Squamous Carcinoma. (AU)

Detection of peripheral blood circulating tumor cells in oral squamous cell carcinoma and its clinical significance / 华西口腔医学杂志

OBJECTIVES@#This study aims to investigate the diagnostic value of peripheral blood circulating tumor cells (CTCs) in oral squamous cell carcinoma (OSCC) and its correlation with the clinicopathological features of OSCC.@*METHODS@#Ninety-three patients diagnosed as OSCC in the First Affiliated Hospital of Zhengzhou University from May 2019 to May 2020 were selected as the experimental group, and 20 healthy volunteers were employed as the control group. The CTCs value of peripheral blood of the patients were measured by CTCs detection technology, and its clinical significance was analyzed.@*RESULTS@#The CTCs values in the experimental group were higher than those in the control group, and the difference was statistically significant (@*CONCLUSIONS@#Peripheral blood CTCs has important clinical value for early screening, auxiliary diagnosis, evaluation of metastasis, and determination of malignant degree, progression, and pathological grade of OSCC and a relatively reliable tumor detection indicator.

Survival analysis of different methods for classification of lymph node metastases in patients with oral squamous cell carcinoma / Análise de sobrevida com diferentes métodos de classificação de metástases em linfonodos em pacientes com carcinoma espinocelular oral

Introdução: Apesar dos avanços no estadiamento clínico do carcinoma espinocelular (CEC) oral a partir de sua extensão pelo sistema TNM, ainda há necessidade de métodos que classifiquem melhor a doença para predizer o prognóstico e indicar terapia adjuvante. Objetivos: Analisar a influência do número de linfonodos positivos (PN), razão de linfonodos (LNR) e probabilidade log de linfonodos positivos (LODDS) na sobrevida de pacientes com CEC de boca. Pacientes e Métodos: Dados clínico-patológicos de pacientes com CEC de boca tratados com fins curativos por cirurgia e esvaziamento cervical (ND) associado ou não a terapias adjuvantes de 1991 a 2015 foram avaliados retrospectivamente. O impacto do PN, LNR, LODDS e outras variáveis na sobrevida global (OS) e sobrevida livre de doença (DFS) foi avaliado por meio de análises univariada e multivariada. Resultados: Cento e dezenove pacientes foram incluídos neste estudo. Na análise univariada, o PN teve um impacto significativo na OS (p = 0,001) e DFS (p = 0,020), e o LNR teve um impacto estatisticamente significante na OS (p = 0,042). Na análise multivariada com outras variáveis clínicopatológicas relevantes, o PN foi o único fator significativamente independente com influência na OS (p = 0,017), mas não na DFS (p = 0,096). Conclusões: O estudo sugere que a NP é um indicador prognóstico independente para OS e DFS em pacientes com CEC de boca e tem o potencial de complementar a classificação AJCC (2017). O LNR tem potencial para ser um importante indicador prognóstico, mas os métodos para essa classificação requerem mais estudos. O LODDS não demonstrou potencial prognóstico(AU)

Background: Despite the advances in the classification of oral squamous cell carcinoma (OSCC) based on its extension by the TNM system, there is still a need for methods to better segregate the patients to predict prognosis and indicate adjuvant therapy. Objectives: To analyze the influence of the number of positive lymph nodes (PN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in survival of patients with OSCC Methods: Clinicopathologic data from patients with OSCC who were treated with curative purposes by surgery and neck dissection (ND) with or without subsequent adjuvant therapies from 1991 to 2015 was retrospectively assessed. The impact of the PN, LNR, LODDS, and other variables on overall survival (OS) and disease-free survival (DFS) was analyzed in univariate and multivariate analyses. Results: One hundred nineteen patients were included in this study. In the univariate analysis the PN had a significant impact on OS (p=0.001) and DFS (p=0.020), and the LNR had a significant impact on the OS (p=0.042). In the multivariate analysis with other relevant clinicopathologic variables, the PN was the only significantly independent factor influencing in the OS (p=0.017) but not in DFS (p=0.096). Conclusions: The PN is an independent prognostic indicator for OS and DFS in patients with OSCC and has the potential to aggregate the current AJCC classification. The LNR has potential to be an important prognostic indicator, but the methods for this classification require lapidation. The LODDS did not demonstrate prognostic potential(AU)

Carcinoma epidermoide córneo-conjuntival. Presentación de un caso / Squamous cell, corneal-conjunctival carcinoma of. Case report

RESUMEN Se presentó el caso de un paciente masculino de 60 años, blanco, que fue atendido en la Consulta de Oftalmología, del Hospital "Dr. Mario Muñoz", del municipio de Colón, provincia de Matanzas. Refirió que llevaba aproximadamente 20 días, con sensación de cuerpo extraño en el ojo izquierdo, enrojecimiento, secreción constante, fotofobia y una lesión que le había aumentado de tamaño durante este período; la que se tornaba dolorosa durante el parpadeo. Se decidió realizar este trabajo con el objetivo de mostrar los beneficios obtenidos al concluir el tratamiento aplicado a este tipo de tumor (AU).

ABSTRACT The authors present the case of a white male patient, aged 60 years, who assisted the Consultation of Ophthalmology of the Hospital "Dr. Mario Muñoz", of the municipality of Colon. He referred feeling a foreign body in the left eye for already 20 days, presence of redness, constant secretion, photophobia and a lesion that had grown during that period, painful when blinking. The authors decided to write this article with the objective of showing the benefits obtained with the applied treatment in this kind of tumor (AU).

Carcinoma escamocelular em soalho de boca causando destruição mandibular / Squamocellular carcinoma of the mouth floor causing mandibular destruction

O carcinoma espinocelular (CEC) representa o tumor mais frequente dentre todos os cânceres da cavidade oral, com uma média de idade de 60 anos e maior ocorrência no sexo masculino. A característica clássica da lesão é de um nódulo endurecida, com sinais e sintomas que se diferem de acordo com a região oral acometida, muitas dessas lesões são indolores, o que pode causar um retardo no diagnóstico e tratamento da doença. Objetivo: relatar um caso clínico de um paciente com CEC em soalho bucal, ressaltando a importância de o cirurgião-dentista reconhecer e diagnosticar essa doença em estágios iniciais. Relato de caso: paciente do sexo masculino, 60 anos de idade, faioderma, tabagista, foi encaminhado para avaliação de lesão indolor em soalho de boca. No exame clínico, observou-se lesão nodular endurecida em soalho de boca com aproximadamente 3 cm de diâmetro, com presença de placas leucoplásicas em sua extensão e associada à ulceração na região de rebordo alveolar. O exame radiográfico panorâmico mostrou reabsorção óssea na região de ulceração. Foram realizadas a biópsia incisional da lesão e a análise histopatológica, em que foi compatível com CEC. O paciente foi encaminhado para tratamento oncológico. Considerações finais: assim, é imprescindível ressaltar a importância de um adequado exame clínico, bem como do diagnóstico precoce destas lesões malignas, favorecendo um bom prognóstico ao paciente.(AU)

Squamous cell carcinoma (SCC) represents the most frequent tumor among all cancers of the oral cavity, with an average age of 60 years and greater occurrence in males. The classic characteristic of the lesion is a hardened nodule, with signs and symptoms that differ according to the affected oral region, many of these lesions are painless, which can cause a delay in the diagnosis and treatment of the disease. Objective: to report a clinical case of a patient with CPB on the oral floor, emphasizing the importance of the dental surgeon in recognizing and diagnosing this disease in early stages. Case report: male patient, 60 years old, phaderoderma, smoker, was referred for painless lesion on the floor of the mouth. On clinical examination, a hard nodular lesion was observed on the floor of the mouth, approximately 3 cm in diameter, with the presence of leukoplastic plaques in its extension and was associated with ulceration in the region of the alveolar ridge. The panoramic radiographic examination showed bone resorption in the ulceration region. Incisional biopsy of the lesion and histopathological analysis were performed, in which it was compatible with CPB. The patient was referred for cancer treatment. Final considerations: thus, it is essential to emphasize the importance of an adequate clinical examination, as well as the early diagnosis of these malignant lesions, favoring a good prognosis for the patient.(AU)

Carcinoma epidermoide primitivo de mama en hombre. Presentación de un caso / Primitive Epidermoid Breast Carcinoma in Men. Case Presentation

RESUMEN El carcinoma epidermoide primitivo está considerado el tumor más raro de la mama, con una incidencia que representa solo del 0,04 al 0,075 % de todos los tumores malignos de esta localización. Es una variedad de carcinoma metaplásico constituido por células pavimentosas queratinizantes. Se presenta el caso de un paciente de sexo masculino, de 65 años, de color de piel blanca, residente en el municipio Abreus, provincia Cienfuegos, que acudió a la consulta de mastología de la provincia por presentar una tumoración de 5 cms. en el cuadrante superior externo de la mama derecha, de dos meses de evolución. Se realizó exéresis de la tumoración y se recibió informe de la biopsia con el resultado de carcinoma epidermoide poco diferenciado. Actualmente el paciente se sigue en consulta y está libre de metástasis. Por lo inusual del caso se decide su publicación. Se presenta este reporte por ser el primer paciente de sexo masculino, operado de carcinoma epidermoide de mama en la provincia Cienfuegos.

ABSTRACT Primitive epidermoid carcinoma is considered the rarest breast tumor, with an incidence that represents only 0.04 to 0.05 % of all malignant tumors of this location. It is a variety of metaplastic carcinoma made up of keratinizing pavement cells. The case presented is a 65-year-old white male patient, resident in the Abreus municipality, Cienfuegos province who attended the province's mastology clinic for presenting a 5 cm tumor in the upper external quadrant of the right breast, two months in evolution. Exeresis of the tumor was performed and a report of the biopsy was received with the result of poorly differentiated squamous cell carcinoma. Currently the patient is followed in consultation and is free of metastases. Due to the unusual nature of the case, its publication is decided. This report is presented as the first male patient to undergo surgery for squamous cell carcinoma of the breast in the Cienfuegos province.

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).

TMPO-AS1 is an independent prognostic factor for patients with laryngeal squamous cell carcinoma

SUMMARY OBJECTIVE Long noncoding RNA (lncRNAs) are frequently abnormally expressed in tumors and involved in the occurrence and progression of human cancer. Recently, a disease-related lncRNA, TMPO antisense RNA 1 (TMPO-AS1), was identified to be dysregulated in several tumors. Hence, we aimed to demonstrate whether TMPO-AS1 could be a promising prognostic marker for patients with laryngeal squamous cell carcinoma (LSCC). METHODS RT-PCR was performed to test TMPO-AS1 expressions in 187 LSCC specimens compared with matched normal specimens. Chi-squared tests were used to determine the associations between TMPO-AS1 expressions and the clinicopathological characteristics of LSCC patients. Then, the clinical outcome of LSCC patients who had lower or higher TMPO-AS1 expression was analyzed using Kaplan-Meier assays. Finally, a Cox proportional hazards model was carried out to evaluate the prognostic values of TMPO-AS1 and other clinical features. RESULTS We found that TMPO-AS1 was distinctly upregulated in human LSCC tissues compared with corresponding normal specimens (p < 0.01). Higher expressions of TMPO-AS1 were observed to be positively associated with the clinical stage (p = 0.020) and lymph node metastasis (p = 0.027). A clinical study in 187 patients revealed that patients with TMPO-AS1 low expressions had poorer survival than those with TMPO-AS1 high expressions (p = 0.0012). In addition, the result of multivariate assays demonstrated TMPO-AS1 expression is an independent predictor for the overall survival of LSCC patients. CONCLUSIONS TMPO-AS1 might be considered a novel molecule involved in LSCC progression, which provides a possible prognostic biomarker.

RESUMO OBJETIVO RNAs longos não-codificantes (INcRNAs) são frequentemente expressos anormalmente em tumores e estão envolvidos na ocorrência e progressão do câncer humano. Recentemente, um INcRNA relacionado com a doença, o TMPO antisense RNA 1 (TMPO-AS1), foi identificado como desregulado em vários tumores. Por isso, procuramos demonstrar se o TMPO-AS1 poderia ser um marcador de prognóstico promissor para pacientes com carcinoma de células escamosas da laringe (LSCC). MÉTODOS RT-PCR foi realizado para medir as expressões do TMPO-AS1 em 187 espécimes de LSCC em comparação com espécimes normais correspondentes. Foram utilizados testes Qui-quadrado para determinar as associações entre as expressões do TMPO-AS1 e as características clínicas dos pacientes com LSCC. Em seguida, o desfecho clínico dos pacientes com LSCC que tinham uma expressão do TMPO-AS1 inferior ou superior foi analisado com ensaios Kaplan-Meier. Por último, o modelo de riscos proporcionais de Cox foi utilizado para avaliar o valor prognóstico do TMPO-AS1 e outras características clínicas. RESULTADOS Observamos que o TMPO-AS1 estava claramente super-regulado nos tecidos de LSCC humanos em comparação com os espécimes normais correspondentes (p<0,01). Expressões mais elevadas de TMPO-AS1 estavam positivamente associadas ao estágio clínico (p=0,020) e à metástase linfática (p=0,027). Um estudo clínico com 187 pacientes revelou que aqueles com expressões mais baixas de TMPO-AS1 tiveram uma sobrevida pior do que aqueles com expressões elevadas de TMPO-AS1 (p=0,0012). Além disso, o resultado de ensaios multivariados demonstrou que a expressão do TMPO-AS1 é um preditor independente para a sobrevida global de pacientes com LSCC. CONCLUSÕES TMPO-AS1 pode ser considerado uma molécula nova envolvida na progressão do LSCC, o que proporciona um possível biomarcador de prognóstico.

Presentación inusual de epitelioma curriculatum en escolar de 12 años / Unusual presentation of curriculatum epitelioma in a 12 years old schoolchild

Introducción: El carcinoma verrugoso es una variante inusual bien diferenciada del carcinoma epidermoide que tiende a aparecer en adultos de mediana edad o mayores. Se considera una neoplasia maligna de grado bajo con cuatro subtipos principales. Objetivo: Referir la infrecuente presentación del carcinoma verrugoso en un adolescente. Presentación de caso: Escolar masculino de 12 años de edad, de raza mestiza, que acude a Consulta Especializada de Dermatología en el Hospital Clínico Quirúrgico Docente Celia Sánchez Manduley con lesión vegetante localizada en planta de pie derecho; se realizan complementarios, biopsia excisional más injerto y se concluye el caso como epitelioma curriculatum. Conclusiones: A nivel clínico, los carcinomas verrugosos se presentan en forma de tumores exofíticos con una superficie papilomatosa o verrugosa. Se asocian con frecuencia a la infección por el virus del papiloma humano, y puede ser difícil distinguir entre un carcinoma verrugoso y una verruga. Es importante el reconocimiento temprano para guiar un diagnóstico preciso y tratamiento oportuno(AU)

Introduction: Verrucous carcinoma is a well differentiated unusual variant of squamous cell carcinoma that tends to occur in middle-aged or older adults. It is considered a low-grade malignant tumour with four main subtypes. Objective: To explain the uncommon presentation of the verrucous carcinoma in a teenager and the importance of early recognition to guide an accurate diagnosis and a timely treatment. Case presentation: 12 years old, school age male, mixed race who attends to specialized consultation of Dermatology in Celia Sánchez Manduley Surgical Clinical Hospital presenting a vegetating lesion located in the right foot´s sole; there were made complementary blood tests, an excisional biopsy plus graft and the case was finally diagnoses as curriculatum epithelioma. Conclusions: At the clinical level, the verrucous carcinomas are presented in the form of exophytic tumors with a papillomatous or verrucous surface. They are often associated with the human papilloma virus infection, and it may be difficult to distinguish between a verrucous carcinoma and a wart(AU)

Inmunohistoquímica de p16 y p53 en cáncer de vulva / Immunohistochemistry of p16 and p53 in vulvar cancer

El carcinoma escamoso vulvar puede desarrollarse de manera asociada o independiente a la infección por HPV. La relación entre la patogénesis, la clasificación, el perfil inmunohistoquímico, y el pronóstico ha sido estudiada con algunas discrepancias. El objetivo del trabajo fue observar la concordancia clásicamente descripta que asocia a los carcinomas queratinizantes con la ausencia de infección por HPV y a los carcinomas warty y basaloides con la presencia de dicho virus. Para ello, revisamos la clínica, la morfología y el inmunofenotipo de 39 casos de nuestro hospital. Los tumores fueron clasificados histológicamente en carcinomas escamosos queratinizantes clásicos (30), warty (5) y basaloides (4). En el análisis estadístico la expresión de p16 fue asociada de manera significativa con una edad menor al momento del diagnóstico (p = 0.0025), presencia de lesión intraepitelial escamosa de alto grado (p < 0.0001), coilocitosis (p = 0.02), y subtipo morfológico (p = 0.02); y fue inversamente asociado con la expresión de p53 (p < 0.0001) y con el liquen escleroso (p = 0.0051). Resulta peculiar que, de los casos estudiados, 4 carcinomas queratinizantes coexpresaron p16 y p53. Un solo tumor de tipo warty resultó negativo para p16 y positivo para p53, y 9 queratinizantes resultaron positivos para p16 y negativos para p53. Si bien estos hallazgos indican que con la sola utilización de la hematoxilina y eosina podrían definirse de manera correcta los tumores asociados al HPV, sugerimos fuertemente la realización de inmunohistoquímica, especialmente en carcinomas escamosos queratinizantes en pacientes jóvenes o con historia de HPV.

Squamous cell carcinoma of the vulva may develop in association or independently of HPV infection. The relationship between pathogenesis, classification, immunohistochemical profile and prognosis has been studied in the literature with some discrepancies. The aim of this study was to observe the classical association of keratinizing carcinomas with the absence of HPV infection and warty and basaloid carcinomas with the presence of this virus. Therefore, we reviewed the clinic, morphology, and immunophenotype of 39 cases. The tumors were histologically classified into classic keratinizing squamous carcinoma (30), warty (5) and basaloid (4). In the statistical analysis, diffuse expression with p16 was significantly associated with younger age (p = 0.0025), presence of high-grade intraepithelial lesion (p < 0.0001), koilocytosis (p = 0.02), and morphological subtype (p = 0.02), and was inversely associated with the expression of p53 (p < 0.0001) and the presence of lichen sclerosus (p = 0.0051). It is curious that 4 keratinizing carcinomas of the cases studied presented coexpression of p16 and p53. Only one warty tumor was negative for p16 and positive for p53, and 9 keratinizing tumors were positive for p16 and negative for p53. Although these findings show that the use of hematoxylin and eosin could correctly define tumors associated with HPV, we strongly suggest the performance of immunohistochemistry, especially in squamous keratinizing classic carcinomas in young patients with a history of HPV.

Sobrevida de adultos jovens com carcinoma de células escamosas oral em uma população do Brasil / Survival of young adults with oral squamous cell carcinoma in a brazilian population / Supervivencia de adultos jóvenes con carcinoma de células escamosas orales en una población de Brasil

RESUMO Objetivo Analisar o perfil e a sobrevida de adultos jovens com carcinoma de células escamosas oral, atendidos entre 2010 a 2016 na Unidade de Alta Complexidade em Oncologia de Feira de Santana, Brasil. Métodos Coorte retrospectiva, realizada através das informações dos prontuários de todos os pacientes jovens atendidos no referido centro. Foi realizada análise descritiva das variáveis, teste exato de Fisher, curva de Kaplan-Meier e teste log rank. Resultados Um total de 35 pacientes foram registrados. A maioria era do sexo masculino, fumantes e etilistas. Os tumores estavam localizados predominantemente em língua, diagnosticados tardiamente e classificados como bem diferenciado, tendo como tratamento de escolha cirurgia associada a radioterapia e quimioterapia. O tempo mediano de sobrevida foi de 31 meses e 22,8% dos pacientes foram a óbito. As variáveis que apresentaram significância estatística em relação ao tempo de sobrevida foram a localização do tumor e o tipo de tratamento. Conclusão O perfil e o baixo tempo de sobrevida refletem a necessidade de uma maior atenção à doença nesta população.(AU)

ABSTRACT Objective To analyze the profile and survival in young adults with oral squamous cell carcinoma, attended at the High Complexity in Oncology of Feira de Santana, Brazil, between 2010 and 2016. Methods Retrospective cohort, performed through the information of the medical records of all young patients attended in the referred center. Descriptive analysis of the variables, Fisher's exact test, Kaplan-Meier curve and log-rank test were performed. Results A total of 35 patients were registered. The majority were male, smokers and former alcoholics. Tumors were predominantly localized in the tongue, diagnosed at late stages, classified as well differentiated and treated mainly with surgery associated to radiotherapy and chemotherapy. The median survival time was 31 months and 22.8% of the patients died. The variables that presented statistical significance in relation to the survival time were the tumor site and the type of treatment. Conclusion The profile and low survival time reflect the need for greater attention to the disease in this population.(AU)

RESUMEN Objetivo Analizar el perfil y la supervivencia de adultos jóvenes con carcinoma de células escamosas atendidos en el Centro de Alta Complejidad en Oncología de Feira de Santana (Brasil), durante el periodo 2010-2016. Métodos cohorte retrospectivo realizado mediante la información de registros médicos de todos los pacientes jóvenes atendidos en el centro médico mencionado. Asimismo, se hizo un análisis descriptivo de las variables, test exacto de Fisher, curva de Kaplan-Meier y una prueba de rango logarítmico. Resultados Se registró un total de 35 pacientes: la mayoría, hombres fumadores y exalcohólicos. Gran parte de los tumores fueron hallados en la lengua y diagnosticados en la última fase; asimismo, se clasificaron, se diferenciaron y se trataron con cirugía apoyada en radioterapia y quimioterapia. El tiempo promedio de supervivencia fue de 31 meses. El 22,8% de los pacientes fallecieron. Las variables que demostraron una gran significancia estadística en relación con el tiempo de supervivencia fueron la ubicación del tumor y el tipo de tratamiento. Conclusión El perfil y el escaso tiempo de supervivencia demuestran que es necesaria una mejor atención de la enfermedad que padece esta población.(AU)

Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel

Abstract: Background: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). Objectives: To evaluate QoL in patients with primary cutaneous SCC. Methods: A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. Results: Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). Study limitations: There is no gold standard instrument for assessing QoL in dermatological patients. Conclusion: In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.

Retalho de peitoral maior estendido e pediculado para reconstrução de região orbito-fronto-parietal direita após exérese de carcinoma espinocelular invasivo / Extended and pedicled pectoralis major flap for right orbitofrontal-parietal reconstruction following invasive squamous cell carcinoma resection

Introdução: O retalho miocutâneo de peitoral maior é um dos mais usados na reconstrução de defeitos da cabeça e pescoço, porém com restrição ao terço médio da face. Com técnicas de dissecção de perfurantes, consegue-se alongar mais o pedículo, obtendo coberturas da região orbito-fronto-parietal. Relato de Caso: Paciente masculino de 63 anos apresentando carcinoma espinocelular invasivo pouco diferenciado, que após sua ressecção cirúrgica apresentou defeito final de 12,0 x 18,0cm na região órbito-fronto-parietal direita com exposição de dura-máter, seio frontal e órbita superior direita. Foi desenhado retalho de peitoral maior com ilha cutânea de dimensões iguais ao defeito na região paraesternal direita, desde o quarto espaço intercostal até a região subcostal (estendido). O pedículo foi seccionado após 4 semanas. A cobertura foi efetiva, sem complicações maiores e resultado estético satisfatório. Conclusão: Este retalho mostrou ser uma excelente opção para reconstrução do terço superior da cabeça quando existam limitações para a realização de microcirurgia.

Introdução: O retalho miocutâneo de peitoral maior é um dos mais usados na reconstrução de defeitos da cabeça e pescoço, porém com restrição ao terço médio da face. Com técnicas de dissecção de perfurantes, consegue-se alongar mais o pedículo, obtendo coberturas da região orbito-fronto-parietal. Relato de Caso: Paciente masculino de 63 anos apresentando carcinoma espinocelular invasivo pouco diferenciado, que após sua ressecção cirúrgica apresentou defeito final de 12,0 x 18,0cm na região órbito-fronto-parietal direita com exposição de dura-máter, seio frontal e órbita superior direita. Foi desenhado retalho de peitoral maior com ilha cutânea de dimensões iguais ao defeito na região paraesternal direita, desde o quarto espaço intercostal até a região subcostal (estendido). O pedículo foi seccionado após 4 semanas. A cobertura foi efetiva, sem complicações maiores e resultado estético satisfatório. Conclusão: Este retalho mostrou ser uma excelente opção para reconstrução do terço superior da cabeça quando existam limitações para a realização de microcirurgia.

Downregulation of Notch4 - a prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma / Regulação descendente de Notch4 - um marcador prognóstico na distinção entre carcinoma verrucoso oral e carcinoma de células escamosas oral

Abstract Introduction: Oral verrucous carcinoma is a special form of well-differentiated squamous cell carcinoma which possesses specific clinical, morphologic and cytokinetic features that differ from other types of oral cancers and hence diagnosis requires immense experience in histopathology. Hence it is certainly important to distinguish such a lesion from other oral tumors as treatment strategies vary widely between them. Objective: In search of a critical diagnostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma, Notch4 receptor, one of the key regulatory molecules of the Notch signaling family has been aberrantly activated in the progression of several types of tumors. However its function in oral verrucous carcinoma remains unexplored. Thus the present study aims in determining the differential expression pattern of Notch4 in oral verrucous carcinoma and oral squamous cell carcinoma. Methods: Ten patients reported positive for oral cancer (5 patients with oral verrucous carcinoma and 5 patients with oral squamous cell carcinoma). Five normal tissue samples were also obtained and evaluated for clinicopathological parameters and immunohistochemistry, western blotting and real time polymerase chain reaction for Notch4 expression. Results: Our results reveal that the expression of Notch4 was considerably high in oral squamous cell carcinoma lesions compared to normal tissue, whereas in oral verrucous carcinoma, irrespective of the clinicopathological features, complete regulação descendente of Notch4 was observed. Conclusions: These preliminary findings strongly support the fact that Notch4 is downregulated in oral verrucous carcinoma and could be considered as a suitable prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma. This distinguishing marker can help in improving therapeutic options in patients diagnosed with oral verrucous carcinoma.

Resumo Introdução: O carcinoma verrucoso de cavidade oral é uma forma especial de carcinoma de células escamosas bem diferenciada que tem características clínicas, morfológicas e citocinéticas específicas que diferem de outros tipos de cânceres orais. Por essa razão, o diagnóstico requer grande experiência em histopatologia. Portanto, é certamente importante distingui-lo de outros tumores orais, pois as respectivas estratégias de tratamento variam muito. Objetivo: Em busca de um marcador de diagnóstico crítico na distinção entre o carcinoma verrucoso e o carcinoma de células escamosas de cavidade oral, o receptor Notch4, uma das principais moléculas reguladoras da família de sinalizadores Notch, foi ativado de maneira anormal na progressão de vários tipos de tumores. No entanto, sua função no carcinoma verrucoso permanece inexplorada. Assim, o presente estudo tem como objetivo determinar o padrão de expressão diferencial de Notch4 no carcinoma verrucoso e de células escamosas de cavidade oral. Método: Dez pacientes tiveram resultado positivo para câncer oral (cinco pacientes com carcinoma verrucoso e cinco pacientes com carcinoma de células escamosas) e cinco amostras normais foram também obtidas. Além da avaliação dos parâmetros clínico-patológicos, foram feitos análise imuno-histoquímica, Western Blot e reação de polimerase em cadeia em tempo real para a expressão de Notch4. Resultados: Nossos resultados revelam que a expressão de Notch4 foi consideravelmente alta em carcinomas de células escamosas em comparação com os tecidos normais, enquanto que no carcinoma verrucoso, independentemente das características clínico-patológicas, observou-se regulação descendente completa de Notch4. Conclusão: Esses achados preliminares apoiam fortemente o fato de que Notch4 estava regulado para baixo no carcinoma verrucoso oral e poderia ser considerado um marcador prognóstico adequado para distinguir entre carcinoma verrucoso e carcinoma de células escamosas de cavidade oral. Esse marcador distintivo pode ajudar a melhorar as opções terapêuticas em pacientes com diagnóstico de carcinoma verrucoso oral.

Delayed diagnosis of oral squamous cell neoplasms at different sites / 北京大学学报(医学版)

OBJECTIVE@#To investigate the diagnostic delay of patients with oral squamous cell carcinoma by self-designed questionnaire to find out the significant influencing factors, so as to identify the influencing factors of the patient's delay and the risk of oral cancer.@*METHODS@#A total of 514 patients with primary oral squamous cell carcinoma were enrolled at Peking University School and Hospital of Stomatology from January 2014 to April 2016, including 334 men and 180 women, with a male to female ratio of 1.85:1. The youngest participant was 21 years old, with a maximum of 89 years and a median age of 57.6 years. The position of the disease according to International Classification of Diseases-10 (ICD-10) was divided into lip, buccal, gingival, retromolar, palate, floor of the mouth, tongue, and oropharynx. The age group is divided into 10 years. The level of education was divided into illiteracy, primary education level and advanced education level. Body mass index (BMI) was divided into three levels by 18 kg/m2 and 25 kg/m2. Visual analog scale (VAS) method was to evaluate the patient's preoperative pain. At the same time, the patients were examined by detailed questionnaire to understand the delay factors and delay characteristics, and use SPSS 18.0 software, analysis of variance and chi-square test to explore correlation.@*RESULTS@#Among all patients, the proportion of patients developed in the tongue was the highest (43.3%). Delay was defined by a span of three months or longer from the onset of symptoms until treatment. The delays to diagnosis according to location were as follows (in months and in descending order): lip (6.1 months), buccal (4.1 months), floor of the mouth (3.9 months), tongue (3.6 months), oropharyngeal (2.9 months), retromolar (2.7 months), palatine (2.4 months), and gingival (2.4 months). Different sites and delayed diagnosis were statistically significant (P=0.048). There were no statistically significant differences in gender, education, pain, smoking, drinking and VAS score.@*CONCLUSION@#The study has found that tumor positions and delay have a significant correlation. The position of the tumor is an obvious factor associated with the findings. The lip is the most likely to delay the diagnosis of oral positions. For the lip of the lesion, more than three months' obvious mass is recommended for timely treatment, while at admission, physicians should take the appropriate diagnostic method as soon as possible.

Dermoscopy of squamoid eccrine ductal carcinoma: an aid for early diagnosis

Abstract: Squamoid eccrine ductal carcinoma is a cutaneous malignancy that originates from the eccrine sweat gland. A 76-year-old woman presented with an asymptomatic papule on her nose that had been present for one year. Dermoscopy showed pseudocysts, irregular linear crown vessels, and yellowish-brown globules surrounded by white halos. This is the first dermoscopic description of squamoid eccrine ductal carcinoma. Studies with more cases are needed to confirm the dermoscopic characterization of this tumor.