Cáncer de nasofaringe, una revisión de la literatura / Nasopharyngeal Cancer, a literature review

Resumen Introducción: El cáncer de nasofaringe es una patología poco común que tiene gran impacto en la calidad de vida de los pacientes. Con el advenimiento de nuevos esquemas de tratamiento se ha logrado mejorar el pronóstico con un menor índice de morbilidad. Esta revisión describe la perspectiva actual del cáncer de nasofaringe, basado en la literatura reciente y la disponibilidad de recursos para su tratamiento en una institución médica de Medellín, Colombia. Materiales y Método: Se realizó una búsqueda bibliográfica que incluyó artículos desde 1986 hasta 2018 en diferentes bases de datos como MEDLINE, EBSCO y LILACS. Se incluyó literatura escrita en inglés o español, utilizando como términos MESH neoplasias de nasofaringe, diagnóstico y terapéutica. Resultados: La evaluación diagnóstica oportuna del cáncer de nasofaringe es de vital importancia al proporcionar una estrategia de tratamiento efectiva con menor morbimortalidad. Según la experiencia institucional de los autores, en las etapas clínicas tempranas, se sugiere la radioterapia radical como modalidad única y en etapas intermedias-avanzadas los tratamientos combinados con quimioterapia-radioterapia concomitante o secuencial dependiendo de cada paciente y quimioterapia única en pacientes metastásicos a distancia. Conclusiones: Acorde con el análisis de la literatura y evidencia existente, las estrategias utilizadas son adaptadas a los alcances de la institución como ente de alto nivel en el sector salud. La cirugía representa un papel relevante en la enfermedad recurrente resecable ya sea con técnica endoscópica o abierta. Es importante recordar que la morbilidad postoperatoria no es inocua, y en ocasiones sobrepasa el beneficio obtenido.

Introduction: Nasopharyngeal cáncer is a rare disease that has a huge impact on the quality of life. Survival rates are steadily improving due to new treatments with a lower morbidity index. This review describes the current perspective of nasopharyngeal cancer, based on recent literature and the availability of resources for treatment in the different specialties of an institution in Medellin, Colombia. Materials and Method: A literature review was carried out, including articles from 1986 to 2017 in different databases such as MEDLINE, EBSCO and LILACS. Written literature in English or Spanish was included, using MESH terms as Nasopharyngeal, diagnostic and therapeutic neoplasms. Results: Nasopharyngeal cancer timely diagnostic is of vital importance. According to the institutional experience, in early clinical stage radiotherapy is suggested as a single modality. Intermediate stages treatments options are concurrent chemo radiotherapy or sequential radiotherapy according to each patient case. In distant metastatic stage single chemotherapy is used. Conclusions: According to existing evidence strategies used are adapted to the scope of the institution as a high-level entity in health sector. Surgery represents a relevant role in recurrent resecable disease with either endoscopic or open technique. It is important to remember that postoperative morbidity is not harmless, and sometimes exceeds the benefit obtained.

Plasmocitoma extramedular de laringe: a propósito de un caso / Extramedullary plasmacytoma of the larynx: a case report

Resumen Los plasmocitomas solitarios son una rara forma de presentación de neoplasias de células plasmáticas. Deben ser diferenciados del mieloma múltiple en el momento del diagnóstico y realizar un seguimiento estricto por el riesgo de transformación a mieloma. La localización de los mismos en la laringe es muy inusual, dado que sólo se han publicado 56 casos. Se presenta el caso de una paciente con un plasmocitoma extramedular de laringe que se trató mediante cirugía y radioterapia. Se revisan los criterios diagnósticos y los problemas terapéuticos.

Abstract Solitary plasmacytomas are a rare form of plasma cell neoplasms. They should be differentiated from multiple myeloma at the time of diagnosis and strictly monitored for the risk of transformation to myeloma. Their location in the larynx is very unusual, since only 56 cases have been published. We present the case of a patient with extramedullary plasmacytoma of the larynx that has been treated with surgery and radiotherapy. We reviewed the literature for diagnostic criteria and therapeutic problems.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases / O papel do exame clínico e da biópsia de nasofaringe no diagnóstico de doenças malignas

Abstract Introduction: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. Objectives: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. Methods: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. Results: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001). Conclusion: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

Resumo Introdução: Em proporção direta à taxa crescente de exames de nasofaringe que são feitos, o diagnóstico precoce e o tratamento de lesões nessa região têm sido possíveis. Nem sempre os achados clínicos e os resultados da primeira biópsia são consistentes, levando à necessidade de biópsias repetidas. Objetivos: Avaliar a distribuição dos resultados dos testes histopatológicos obtidos pela biópsia de nasofaringe, determinar quais métodos foram mais frequentemente usados na identificação e investigar os casos nos quais a biópsia precisou ser repetida. Método: O estudo incluiu 1.074 pacientes (500 mulheres, 574 homens) submetidos a biópsia de nasofaringe em nossa clínica entre junho de 2011 e junho de 2017. Os dados foram obtidos dos prontuários dos pacientes e incluíram idade, sexo, achados clínicos, achados de imagem e diagnóstico histopatológico. Os diagnósticos histopatológicos foram separados em três grupos principais como nasofaringite crônica, citologia benigna e citologia maligna. Resultados: Os exames resultaram em 996 casos laudados como nasofaringite crônica, 47 como citologia benigna e 31 como citologia maligna. Das 31 lesões malignas, o diagnóstico foi feito em 15 (48,4%) com uma única biópsia e em 16 (51,6%), quando duas ou mais biópsias foram feitas. Na comparação das lesões benignas e malignas em relação à necessidade de biópsias repetidas, os casos determinados como malignos mostraram uma taxa estatisticamente maior de biópsia repetida (p < 0,001). Conclusão: Em comparação com os casos de tumores benignos, um número estatisticamente maior de biópsias repetidas foi necessário em casos diagnosticados como tumores malignos, para confirmação do diagnóstico histopatológico ou na suspeita continuada de malignidade. Portanto, quando há suspeita clínica, mesmo que não haja achados de malignidade na primeira biópsia, ela deve ser repetida tão logo seja possível.

Fibroangioma nasofaríngeo juvenil. Experiencia en 89 pacientes / Juvenile nasopharyngeal angiofibroma. An experience of 89 patients

El fibroangioma nasojuvenil (FANJ) es un tumor benigno, localmente invasivo, que se presenta en varones púberes y adolescentes. Se manifiesta clínicamente por insuficiencia ventilatoria nasal progresiva y epistaxis. Con el objetivo de describir las características clínico quirúrgicas se realizó un estudio observacional, retrospectivo, transversal de los FANJ intervenidos quirúrgicamente en el período enero 2000 a diciembre 2017 en el Hospital de Pediatría Juan P. Garrahan. Resultados: se incluyeron 89 pacientes con diagnóstico de fibroangioma nasojuvenil intervenidos quirúrgicamente. El 71% de los pacientes menores de 14 años. El síntoma predominante fue epistaxis en el 91% de los casos. El 80,1% (72/89) estaban incluidos en los estadios III y IV de Chandler presentando digitaciones a fosa pterigomaxilar y senos paranasales. El 29,2% (26/89) de los casos presentaba invasión a endocráneo. En el 96% (86/89) se realizó embolización prequirúrgica de las ramas nutricias del tumor. Los abordajes quirúrgicos más utilizados fueron: la vía transantral en el 43,8% (39/89), abordaje de Le Fort 1 en el 21,3% (19/89), endoscópico en el 12,3% (11/89), abordaje combinado con neurocirugía en el 12,3% (11/89) de los pacientes. La recurrencia fue de 33,7% y no hubo pacientes fallecidos. Conclusiones: El fibroangioma nasojuvenil es una patología tumoral que requiere para su resolución un equipo multidisciplinario en instituciones con infraestructura de alta complejidad. El abordaje quirúrgico debe seleccionarse de acuerdo a la localización y extensión tumoral, la efectividad de la embolización previa, la edad del paciente y la experiencia del equipo quirúrgico (AU)

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, locally invasive tumor, occurring in pubertal and adolescent males. Clinically the tumor manifests with progressive nasal obstruction and epistaxis. With the aim to describe the clinical and surgical features, an observational, retrospective, cross-sectional study was conducted in patients with JNA who underwent surgery at Hospital de Pediatría Juan P. Garrahan between January 2000 and December 2017. Results: Overall, 89 patients diagnosed with JNA who underwent surgery were included; 71% were under 14 years of age. The main symptom was epistaxis occurring in 91% of the cases. Of all patients, 80.1% (72/89) were in Chandler stages III and IV with extension into the pterygomaxillary fossa and paranasal sinuses. Intracranial invasion was found in 29.2% (26/89) of the cases. In 96% (86/89), preoperative embolization of the feeding branches of the tumor was performed. The most commonly used surgical approaches were: The transantral approach in 43.8% (39/89), Le Fort 1 in 21.3% (19/89), endoscopic approach in 12.3% (11/89), and an approach combined with neurosurgery in 12.3% (11/89) of patients. Recurrence rate was 33.7% and none of the patients died. Conclusions: Management of JNA a multidisciplinary team at a tertiary care institution. The surgical approach should be selected according to tumor location and extension, effectiveness of previous embolization, the patient age, and expertise of the surgical team (AU)

Actinomicosis orofaríngea como diagnóstico diferencial de carcinoma de cavum: Reporte de un caso / Cervicofacial actinomycosis as differential diagnosis of cavum carcinoma: case report

La actinomicosis es una enfermedad infrecuente en pediatría que implica, habitualmente, un desafío diagnóstico. Es producida por bacterias del género Actinomyces. La forma cervicofacial suele originarse tras la disrupción de la mucosa oral secundaria a alteraciones odontógenas. Se presenta el caso de una adolescente que, tras la colocación de un piercing en la lengua, comenzó con odinofagia y cambios del tono de voz. Luego de ocho meses de persistencia de los síntomas y habiendo realizado múltiples tratamientos antibióticos con leve mejoría, se efectuó una biopsia y se diagnosticó carcinoma de cavum, por lo que se derivó a este Hospital para su tratamiento. Al analizar nuevamente la biopsia, se descartó la patología oncológica y se diagnosticó actinomicosis orofaríngea. Cumplió 6 meses totales de tratamiento antibiótico, con buena evolución. Si bien la colocación de piercings orales no ha sido descrita hasta el momento como factor de riesgo, la disrupción mucosa generada podría favorecer el inicio del cuadro.

Paediatric actinomycosis is an infrequent infectious disease caused by Actinomyces spp. Cervicofacial infections are usually related to disruption in oral mucosal membranes. We discuss the case of a 15-year-old girl who refers an 8-month history of odynophagia and changes in her tone of voice after getting a tongue piercing. She received multiple antibiotic treatments with slight improvement. Nasopharyngeal carcinoma was diagnosed by endoscopic biopsy. The patient was referred to our Hospital for treatment but, when the biopsy was analyzed again, oncological pathology was excluded and oropharyngeal actinomycosis was diagnosed. She received a total of 6 months of antibiotic treatment with favorable evolution.

Tumores que comprometen la rinofaringe: nuestra experiencia / Tumors of rhinopharynx: our experience

Las lesiones que comprometen la rinofaringe son de difícil diagnóstico debido al complejo acceso a esta región, excepto cuando éstas alcanzan mayor tamaño o cuando presentan síntomas y/o signos secundarios al compromiso de estructuras adyacentes o de diseminación. El propósito de esta investigación fue analizar y describir casos clínicos de pacientes portadores de patología tumoral de la rinofaringe, con la finalidad de aportar nuevos antecedentes en un área en la cual existen pocos estudios publicados, dada su baja incidencia. Se realizó un análisis descriptivo de corte transversal de 10 casos clínicos de pacientes portadores de patologías que comprometían la rinofaringe, evaluados en la unidad de Otoneurología del Instituto de Neurocirugía (1999-2008). De los casos analizados, se observó una mediana de edad de 52,5 años, el tiempo desde la presentación de los síntomas hasta el diagnóstico fue de 8,5 meses. Los tumores de origen epitelial fueron la causa más frecuente, presentándose además tumores de origen óseo y linfoide. El tratamiento fue quirúrgico y asociado a terapia complementaria según necesidad. El número de casos analizados es pequeño, por lo que no es posible sacar conclusiones, sin embargo, dado la clínica inespecífica es fundamental un alto índice de sospecha, e idealmente en el estudio inicial realizar un examen endoscópico en forma rutinaria.

Lesions of rhinopharynx are difficult to diagnose due to the complex access to this área, except when they reach a greater size or when they present symptoms and/or signs secondary to the compression ofadjacent structures or dissemination. The aim of this study was to analyze and to describe clinical cases of patients with rhinopharynx pathologies, with the purpose of giving new antecedents in an area where are few published studies, due to its low incidence. A cross-sectional descriptive study was made of 10 clinical cases of patients with rhinopharynx tumors, which were evaluated in the unit of Otoneurology of the Neurosurgery Institute (1999-2008). The median age was 52.5 years, and the time since the symptoms appear and the diagnosis was made was of 8.5 months. The most frequent causes were tumors of epithelial origin, but also osseous and lymphoid tumors were observed. Treatment was surgical and/or associated to complementary therapy Due to the small number cases analyzed it is not possible to draw conciusions, nevertheless, it is important to have a high índex of suspicion, given the unspecific symptom and signs that they may present, and idealiy in the initial study of these patients it is necessary to perform an endoscopic evaluation.

Experiência de sete anos em pacientes com angiofibroma nasofaríngeo juvenil / A seven-year experience with patients with juvenile nasopharyngeal angiofibroma

O angiofibroma nasofaríngeo juvenil (ANJ) é um raro tumor em adolescentes masculinos originário na nasofaringe. OBJETIVOS: Apresentar a experiência do tratamento do ANJ em pacientes do Serviço de Otorrinolaringologia entre 2001 e 2008. MATERIAL E MÉTODOS: Foram revisados de prontuários do Serviço de Otorrinolaringologia os dados demográficos, apresentação clínica, métodos de investigação e tratamento de 16 pacientes. DESENHO DO ESTUDO: estudo descritivo, retrospectivo, de corte transversal. Resultados: Todos os pacientes são do gênero masculino e a média de idade ao diagnóstico foi de 16,8 anos (variação de 9 a 23 anos), sendo mais de 56 por cento deles com estádio II de Fisch. Embolização pré-operatória foi realizada em 10 pacientes (62,5 por cento). Todos os 16 pacientes foram submetidos à ressecção cirúrgica. Dois pacientes (66,7 por cento) que não foram submetidos à embolização pré-operatória necessitaram de transfusão sanguínea. O índice de recidiva foi de 43,75 por cento e o índice de cura foi 93,75 por cento. CONCLUSÕES: Embolização pré-operatória diminui a perda sanguínea intra-operatória. O índice de recidiva foi relacionado ao estadiamento avançado do tumor ao diagnóstico e à não-realização de embolização pré-operatória. Cirurgia associada à embolização pré-operatória são os principais tratamentos do ANJ. Todos os pacientes devem ter estudos de imagem pré-operatórios, especialmente tomografia computadorizada, para auxiliar no planejamento cirúrgico e no seguimento.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor in adolescent males. It originates in the nasopharynx. AIM: to present the experience of JNA management at an Otorhinolaryngology Service between 2001 and 2008. MATERIALS AND METHODS: Demographical data, clinical presentation, investigations as well as the treatment of sixteen JNA patients were reviewed and collected from medical records from the ORL Service. DESIGN: Cross-sectional, retrospective and descriptive study. Results: All JNA patients were male. The average age at diagnosis was 16.8 years (range 9-23 years). More than 56 percent of the patients were classified as Fisch II. Preoperative embolization was carried out in ten (62.5 percent) patients. All 16 patients were submitted to primary surgical resection. Two patients (66.7 percent) who didn't receive preoperative embolization required intraoperative blood transfusion. The overall recurrence rate was 43.75 percent and the cure rate was 93.75 percent. CONCLUSION: Preoperative embolization minimizes intraoperative blood loss. The recurrence rate was related to advanced tumoral stage at diagnostic and the lack of preoperative embolization. Surgery combined with preoperative embolization is the major treatment for JNA. All the patients should undergo preoperative imaging studies, especially CT, to assist in surgical planning and follow-up.

Is lateral rhinotomy, an adequate surgical approach for juvenile naso-pharyngeal angiofibroma

The objective of the study was to determine optimal surgical approach in patients with JNA. Retrospective, descriptive. The study was carried out at the department of Ear, Nose, Throat, Head and Neck Surgery, Dow Medical College and Civil Hospital, Karachi from 1996-2007. All the young males who visited out patients department with the history of recurrent intractable epistaxis, nasal obstruction, proptosis, fullness and asymmetry of face and were diagnosed as a case of JNA on the basis of history, clinical examination and CT scan, were included in the study. All the diagnosed cases of recurrent JNA and other causes with similar symptoms were excluded. Almost all the included patients underwent digital subtraction angiography with embolization of main feeding vessel 24-48 hours before surgery. Chandler staging system was used to stage the disease. Lateral rhinotomy approach was employed in majority of the cases for exploration and removal of JNA. The out come were discussed for lateral rhinotomy as an optimal surgical approach in patients with JNA in term of ease of approach, complete removal and recurrence. Total of 53 cases of JNA were included in the study. All were young males between the age group from 8-22 years. Majority of the patients were between 13 to 18 years of age. No female patient was reported. Majority of the patients presented with triad of symptoms with recurrent epistaxis [n-53] nasal obstruction [n-53] and nasal mass [n-41]. Others presented with additional symptoms of nasal discharge [n-46], snoring [n-43] speech defect [n-32], headache [n-23], facial asymmetry [n-20], visual problems, like proptosis and diplopia [n-09] and impairment of hearing [n-19]. Diagnosis was made by clinical examination, C T scan and angiographic findings with embolization 24-48 hour prior to surgery [n-45]. Lateral rhinotomy approach for extirpation of the JNA was employed in 41 cases and Weber-Furguson approach in 07 patients. Midfacial degloving approach was used in 03 patients and in 02 cases transpalatal approach was employed where the extent of the lesion was limited to nasopharynx. Recurrence was found in 03 cases of JNA approached through lateral rhinotomy during 1-2 years follow-up. Lateral rhinotomy approach to nose and nasopharynx gives an adequate exposure in almost all the cases of JNA

Tumor sincrónico en glándula parótida: A propósito de un caso / Synchronic tumor in parotid gland: On the purpose of a case

Paciente de 64 años, masculino, con antecedentes de habérsele realizado BAAF de adenopatía cervical con diagnóstico de metástasis de carcinoma Epidermoide, encontrándose tumor primario en nasofaringe. Se le realiza vaciamiento de cuello hallándose metástasis ganglionar intraparotídea de carcinoma escamoso y Tumor de Warthin sincrónico. Se revisa la literatura no encontrándose referencias de esta dualidad tumoral...

A 64 years-old, male patient, with antecedents of being subject to a BAAF of cervical adenopathy with a diagnostic of epidermoid carcinoma, finding a primary tumor in nasopharynx. We cleared out the neck finding an intra-parotid ganglion metastasis of scaly carcinoma and synchronic Warthin ' s tumor. We review literature and did not find references of this tumor duality.

Biópsia de nasofaringe em Serviço de Otorrinolaringologia: correlação clínico histopatológico / Nasopharyngeal biosy in an Otorhinolaryngology Service: clinical histopathological correlation

Os tumores de nasofaringe são afecções raras. Devido à grande diversidade de lesões dessa região, todos os pacientes com suspeita de tumor em nasofaringe devem se submeter a exame endoscópico nasal e biópsia...

Nasopharyngeal neoplasm are rare diseases. Due to great diversity of lesions affecting this area, all patients suspected to have a nasopharyngeal neoplasm should be submitted to nasal endoscopy and biopsy...