Clinicopathological study in 28 cases of oral basaloid squamous cell carcinomas / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinicopathologic features and prognostic factors in oral basaloid squamous cell carcinoma.@*METHODS@#Retrospective analysis of oral basaloid squamous cell carcinomas patients who underwent tumor resection during the period from January 2002 to December 2020 in the authors' hospital, especially the clinicopathologic characteristics of 28 cases with confirmed diagnosis and follow-up data. Immunohistochemistry was performed to define the helpful markers for differentiation diagnosis. The factors influencing the prognosis were evaluated based on Kaplan-Meier method.@*RESULTS@#The tongue and mouth floor (11 cases, 39.3%) were the most frequently involved sites, followed by gingiva (6 cases, 21.4%), buccal (5 cases, 17.9%), palate (4 cases, 14.3%), and oropharynx (2 cases, 7.1%). The majority of basaloid squamous cell carcinomas were in advanced stage, with 12 cases in stage Ⅱ and 16 cases in stages Ⅲ-Ⅳ. Twelve of 28 patients were identified to have cervical lymph node metastasis, which was confirmed by histopathological examination. The incidence rate of lymph node metastasis was 42.9% (12/28). Nine tumors recurred, with one metastasized to the lung. At the meantime, the 28 conventional squamous cell carcinomas were matched with the same stage, among which 13 cases were identified with cervical lymph node metastasis. The incidence rate of lymph node metastasis was 46.4% (13/28). Five cases recurred, with two cases that metastasized to the lung and one to the brain. The 5-year overall survival rates of the basaloid squamous cell carcinoma and conventional squamous cell carcinoma patients were 54.6% and 53.8%, respectively. Histopathologically, basaloid cells consisted of tumor islands without evident keratinization but frequently with comedo-like necrosis within the tumor islands. CK5/6 and P63 exhibited strongly positive in all the 28 cases, whereas neuroendocrine markers, CgA and Syn, were negative. Eight cases positively expressed P16; one case showed focal SOX10 positive but CK7 negative.@*CONCLUSION@#The majority of oral basaloid squamous cell carcinomas present in advanced stage with a high tendency to lymph node metastasis, but the overall survival rates are not significantly different from conventional squamous cell carcinomas matched with the same stage. The human papilloma virus (HPV), as HPV-positivity rate is high, correlates to good prognosis. In addition, CK7 & SOX10 immunohistochemistry could contribute to differential diagnosis for basaloid squamous cell carcinoma with solid adenoid cystic carcinoma.

Basal cell carcinoma with compromised margins: retrospective study of management, evolution, and prognosis

Abstract Background: Non-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial. Objectives: To compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma. Methods: Selection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013. Results: A total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery. Study limitations: Mean follow-up time of less than five years and sample size. Conclusions: The presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.

Sinonasal inverted papilloma: rate of recurrence and malignant transformation in 44 operated patients / Papiloma invertido nasossinusal: taxa de recorrência e transformação maligna em 44 pacientes operados

Abstract Introduction: Although sinonasal inverted papillomas are benign lesions, they are locally aggressive and have a potential malignant transformation ranging from 5% to 15%, with a high recurrence rate. Objective: The aim of this article is to describe the rate of recurrence and malignant transformation in patients with a diagnosis of inverted papilloma who underwent surgery in a tertiary hospital in São Paulo. Methods: We performed a retrospective analysis of patients diagnosed with sinonasal papilloma who had undergone surgery in a tertiary hospital in São Paulo, between August 1998 and August 2017. A patient chart review was conducted to assess data of patients' demographics, tumors characteristics, follow-up appointments, recurrence and malignancy. Inverted papillomas were analyzed and classified under the Krouse staging system. Results: A total of 69 surgeries were performed in patients with diagnosis of sinonasal papilloma. Inverted papilloma was the most prevalent subtype (49 cases ‒ 80.33%), followed by exophytic papilloma (6 cases ‒ 9.84%) and by oncocytic papilloma (6 cases - 9.84%). The recurrence rate was 34.09% for inverted papilloma (15/44) and the mean time of recurrence was 24.6 months. Malignant transformation occurred in 6 patients (13.64%). Three of these patients presented carcinoma in the first surgery and three patients developed carcinoma during the follow-up. Conclusion: The high recurrence rate and malignancy potential allow us to consider inverted papillomas as aggressive tumors. In a tertiary hospital in São Paulo the recurrence rate the mean time to recurrence is 24.6 months. The recurrence after 10 years implies was 34.09% and the need for long-term follow up. It is possible that the high recurrence rate and the high malignant transformation rate we found are due to the large number of tumors discovered at an advanced stage (most of them staged T3 and T4), secondary to poor access to health system, in developing countries.

Resumo Introdução: Embora os papilomas invertidos nasossinusais sejam lesões benignas, eles são localmente agressivos e apresentam uma potencial transformação maligna que varia de 5% a 15%, com alta taxa de recorrência. Objetivo: Descrever a taxa de recorrência e transformação maligna em pacientes com diagnóstico de papiloma invertido submetidos à cirurgia em um hospital terciário em São Paulo. Método: Análise retrospectiva dos pacientes diagnosticados com papiloma nasossinusal submetidos a cirurgia em um hospital terciário em São Paulo, entre agosto de 1998 e agosto de 2017. Uma revisão de prontuários dos pacientes foi realizada para avaliar dados demográficos, características dos tumores, consultas de seguimento, recorrência e malignidade. Os papilomas invertidos foram analisados e classificados de acordo com o sistema de estadiamento de Krouse. Resultados: Foram realizadas 69 cirurgias em pacientes com diagnóstico de papiloma nasossinusal. O papiloma invertido foi o subtipo mais prevalente (49 casos - 80,33%), seguido pelo papiloma exofítico (6 casos - 9,84%) e pelo papiloma oncocítico (6 casos - 9,84%). A taxa de recidiva foi de 34,09% para o papiloma invertido (15/44) e o tempo médio de recorrência foi de 24,6 meses. Transformação maligna ocorreu em seis pacientes (13,64%); três desses pacientes apresentaram carcinoma na primeira cirurgia e três pacientes desenvolveram carcinoma durante o seguimento. Conclusão: A alta taxa de recorrência e o potencial de malignidade nos permitem considerar os papilomas invertidos como tumores agressivos. Em um hospital terciário de São Paulo, a taxa de recorrência foi de 34,09% e o tempo médio de recorrência de 24,6 meses. A recorrência após 10 anos implica na necessidade de acompanhamento a longo prazo. É possível que a alta taxa de recorrência e a alta taxa de transformação maligna que encontramos sejam devidas à grande extensão dos tumores (a maioria deles nos estágios T3 e T4), decorrente do acesso precário ao sistema de saúde nos países em desenvolvimento.

Recurrence in pn0 gastric cancer: risk factors in the occident

ABSTRACT Background: Nearly 10% of node negative gastric cancer patients who underwent curative surgery have disease recurrence. Western data is extremely poor on this matter and identifying the risk factors that associate with relapse may allow new strategies to improve survival. Aim: Verify the clinical and pathological characteristics that correlate with recurrence in node negative gastric cancer. Methods: All gastric cancer patients submitted to gastrectomy between 2009 and 2019 at our institution and pathologically classified as N0 were considered. Their data were available in a prospective database. Inclusion criteria were: gastric adenocarcinoma, node negative, gastrectomy with curative intent, R0 resection. Main outcomes studied were: disease-free survival and overall survival. Results: A total of 270 patients fulfilled the inclusion criteria. Mean age was 63-year-old and 155 were males. Subtotal gastrectomy and D2 lymphadenectomy were performed in 64% and 74.4%, respectively. Mean lymph node yield was 37.6. Early GC was present in 54.1% of the cases. Mean follow-up was 40.8 months and 19 (7%) patients relapsed. Disease-free survival and overall survival were 90.9% and 74.6%, respectively. Independent risk factors for worse disease-free survival were: total gastrectomy, lesion size ≥3.4 cm, higher pT status and <16 lymph nodes resected. Conclusion: In western gastric cancer pN0 patients submitted to gastrectomy, lymph node count <16, pT3-4 status, tumor size ≥3.4 cm, total gastrectomy and presence of lymphatic invasion, are all risk factors for disease relapse.

RESUMO Racional: Aproximadamente 10% dos pacientes com câncer gástrico submetidos a operação curativa e sem linfonodos acometidos irão apresentam recorrência da doença. Os dados ocidentais são extremamente pobres sobre este assunto e a identificação dos fatores de risco associados à recidiva podem permitir novas estratégias para melhorar a sobrevida. Objetivo: Identificar as características clínicas e patológicas que se correlacionam com recidiva em pacientes com câncer gástrico pN0. Métodos: Foram considerados todos os pacientes com câncer gástrico submetidos à gastrectomia entre 2009 e 2019 em nossa instituição e que na classificação patológica não apresentaram acometimento linfonodal. Os critérios de inclusão foram: adenocarcinoma gástrico, pN0, gastrectomia com intenção curativa, ressecção R0. Os principais desfechos estudados foram: sobrevida livre de doença e sobrevida global. Resultados: Ao todo 270 pacientes preencheram os critérios de inclusão. A idade média foi de 63 anos e 155 eram homens. A gastrectomia subtotal e a linfadenectomia D2 foram realizadas em 64% e 74,4%, respectivamente. A média de linfonodos ressecados foi de 37,6. Câncer gástrico precoce estava presente em 54,1% dos casos. O seguimento médio foi de 40,8 meses e 19 (7%) apresentaram recidiva. A sobrevida livre de doença e sobrevida global foram de 90,9% e 74,6%, respectivamente. Os fatores de risco independentes para pior sobrevida livre de doença foram: gastrectomia total, lesão ≥3,4 cm, status pT avançado e <16 linfonodos ressecados. Conclusão: Os fatores de risco para recidiva no grupo estudado foram: <16 linfonodos ressecados, status pT3-4, tumor ≥3,4 cm, gastrectomia total e presença de invasão linfática.

Sobrevida após exenteração pélvica em câncer de colo de útero recidivado: uma série de cinco casos / Survival after pelvic exenteration in recurrent cervical cancer: a series of five cases

A exenteração pélvica pode curar pacientes com câncer de colo do útero com recorrência central após radioterapia e quimioterapia. A avaliação pré-operatória é essencial para excluir doença metastática e evitar cirurgias desnecessárias nesse cenário. O objetivo do presente estudo é avaliar a sobrevida de uma série de casos de pacientes submetidas à exenteração pélvica em clínica privada de Teresina. Este é o resultado parcial de um estudo observacional, retrospectivo, transversal e descritivo, realizado em uma clínica privada especializada no tratamento do câncer em Teresina, PI, Brasil, de junho de 2002 a fevereiro de 2020. Cinco pacientes foram incluídas no estudo, com idades entre 29 e 62 anos. No presente estudo, a sobrevida mediana foi de 44,8 meses. Duas pacientes estão vivas e sem doença com seguimento de 201 e 5 meses, respectivamente.(AU)

Pelvic exenteration can heal patients with cervical cancer with central recurrence after radiotherapy and / or chemotherapy. Preoperative evaluation is essential to exclude metastatic disease and to avoid unnecessary surgery in this scenario. The objective of the present study is to evaluate the survival of a series of cases of patients submitted to pelvic exenteration in a private clinic in Teresina. This is the partial result of an observational, retrospective, cross-sectional and descriptive study, conducted at a private clinic specialized in cancer treatment in Teresina, Brazil, from June 2002 to February 2020. Five patients were included in the study, aged between 29 and 62 years. In the present study, the median survival was 44,8 months. Two patients are alive and without disease with a follow-up of 201 and 5 months, respectively.(AU)

Recurrence of Cholesteatoma: A Retrospective Study Including 1006 Patients for More than 33 Years

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

Analysis of diagnosis and treatment of 100 patients with Hürthle cell adenoma / 北京大学学报(医学版)

OBJECTIVE@#To summarize and analyze the clinical data and prognosis of the patients with Hürthle cell tumor (HCT) in order to raise the clinicians' awareness of the disease.@*METHODS@#The clinical data on patients with histopathologically proven HCT, without other thyroid carcinomas, were collected retrospectively in Peking University First Hospital from January 2001 to February 2017. All the patients underwent surgery due to thyroid nodules. The follow-up information was also collected.@*RESULTS@#A total of 100 patients were enrolled in the current study. All of them were diagnosed with Hürthle cell adenoma (HCA). There were 77 females and 23 males, with the male-to-female ratio of 1 : 3.3. The average age of these patients was (52±14) years at the time of operation. Fifty-one patients were found their thyroid nodules accidentally by ultrasonography during their health check-ups. 69.4% of the 49 symptomatic patients presented with painless cervical nodules. 83.0% HCA patients were combined with multinodular goiters (MNGs). 88.4% (76/86) patients were euthyroid and 53.8% (21/39) had increasing thyroglobulin levels. The mean longest diameter of HCAs was (3.2±1.5) cm (range: 0.9-7.3 cm) on ultrasonography. There were a series of sonographic features of HCA, such as larger, solidity, hypoecho, a smooth outline, intranodular vascularization, perinodular vascularization, absence of calcification in nodules and absence of enlarged cervical lymph nodes. Compared with the histological diagnosis, the diagnostic accuracy by frozen section (FS) during operation was 97.4%. Twenty-nine patients were followed up with an average period of (49.2±22.1) months and none of them had local recurrence or cervical lymph node metastasis. Six patients accepted thyroid hormone replacement treatment and one had thyrotoxicosis due to over-dose.@*CONCLUSION@#HCA is more common in women. It is often found accidentally by ultrasonography during their health check-ups or presented with painless cervical nodules. It is combined with MNG frequently. HCA exhibits numerous sonographic features but not unique. FS during operation is a reliable method to identify HCA with high diagnostic accuracy. Patients with thyroid hormone administration should be monitored for thyroid function after thyroid surgery.

Surgical management of large hepatocellular carcinoma: the first single-center study from western india / Manejo cirúrgico de grandes carcinomas hepatocelulares: primeiro estudo de um único centro da índia ocidental

ABSTRACT Background: Majority of patients with large size HCC (>10 cm) are not offered surgery as per Barcelona Clinic Liver Cancer (BCLC) criteria and hence, their outcomes are not well studied, especially from India, owing to a lower incidence. Aim: To analyze outcomes of surgery for large HCCs. Methods: This retrospective observational study included all patients who underwent surgery for large HCC from January 2007 to December 2017. The entire perioperative and follow up data was collected and analyzed. Results: Nineteen patients were included. Ten were non-cirrhotic; 16 were BCLC grade A; one BCLC grade B; and two were BCLC C. Two cirrhotic and three non-cirrhotic underwent preoperative sequential trans-arterial chemoembolization and portal vein embolization. Right hepatectomy was the most commonly done procedure. The postoperative 30-day mortality rate was 5% (1/19). Wound infection and postoperative ascites was seen in seven patients each. Postoperative liver failure was seen in five. Two cirrhotic and two non-cirrhotic patients had postoperative bile leak. The hospital stay was 11.9±5.4 days (median 12 days). Vascular invasion was present in four cirrhotic and five non-cirrhotic patients. The median follow-up was 32 months. Five patients died in the follow-up period. Seven had recurrence and median recurrence free survival was 18 months. The cumulative recurrence free survival was 88% and 54%, whereas the cumulative overall survival was 94% and 73% at one and three years respectively. Both were better in non-cirrhotic; however, the difference was not statistically significant. The recurrence free survival was better in patients without vascular invasion and the difference was statistically significant (p=0.011). Conclusion: Large HCC is not a contraindication for surgery. Vascular invasion if present, adversely affects survival. Proper case selection can provide the most favorable survival with minimal morbidity.

RESUMO Racional: A maioria dos pacientes com CHC de grande porte (>10 cm) não tem indicação cirúrgica conforme os critérios do Barcelona Clinic Liver Cancer (BCLC) e, portanto, seus resultados não são bem estudados, principalmente na Índia, devido a uma menor incidência. Objetivo: Analisar os resultados da cirurgia para HCCs de grande porte. Métodos: Este estudo observacional retrospectivo incluiu todos os pacientes submetidos à cirurgia para grandes CHC de janeiro de 2007 a dezembro de 2017. Todos os dados perioperatórios e de acompanhamento foram coletados e analisados. Resultados: Dezenove pacientes foram incluídos. Dez não eram cirróticos; 16 eram BCLC grau A; um BCLC grau B; e dois eram BCLC C. Dois cirróticos e três não-cirróticos foram submetidos à quimioembolização transarterial sequencial pré-operatória e embolização da veia porta. Hepatectomia direita foi o procedimento mais comumente realizado. A taxa de mortalidade pós-operatória em 30 dias foi de 5% (1/19). Infecção da ferida e ascite pós-operatória foram observadas em sete pacientes cada. Insuficiência hepática pós-operatória foi observada em cinco. Dois pacientes cirróticos e dois não cirróticos apresentaram vazamento de bile no pós-operatório. O tempo de internação foi de 11,9±5,4 dias (mediana de 12 dias). A invasão vascular estava presente em quatro pacientes cirróticos e cinco não cirróticos. O acompanhamento médio foi de 32 meses. Cinco pacientes morreram no período de acompanhamento. Sete tiveram recorrência e sobrevida mediana livre de recorrência foi de 18 meses. A sobrevida livre de recorrência cumulativa foi de 88% e 54%, enquanto a sobrevida global cumulativa foi de 94% e 73% em um e três anos, respectivamente. Ambos eram melhores em não-cirróticos; no entanto, a diferença não foi estatisticamente significante. A sobrevida livre de recidiva foi melhor nos pacientes sem invasão vascular e a diferença foi estatisticamente significante (p=0,011). Conclusão: CHC grande não é contraindicação para cirurgia. Invasão vascular, se presente, afeta adversamente a sobrevida. Seleção adequada de casos pode fornecer sobrevida mais favorável com morbidade mínima.

Patterns of recurrence and outcomes of glioblastoma multiforme treated with chemoradiation and adjuvant temozolomide

OBJECTIVES: To assess the patterns of failure and prognostic factors in Brazilian patients with glioblastoma multiforme (GBM) treated with radiotherapy (RT) and concurrent and adjuvant temozolomide (TMZ). METHODS: Patients with diagnosed GBM post-resection received postoperative RT. TMZ was administered concurrently at 75 mg/m2/day for 28 consecutive days and adjuvant therapy at 150-200 mg/m2/day for 5 days every 28 days. Radiographic failure was defined as any new T1-enhancing lesion or biopsy-confirmed progressive enhancement inside of the radiation field. When possible, patients with recurrence were salvaged with metronomic TMZ, either in combination with a local treatment or alone (surgery or re-irradiation). Several prognostic factors were evaluated for overall survival (OS). Univariate and multivariate analyses were performed to identify significant factors. A p-value <0.05 was considered significant. RESULTS: This study included 50 patients. The median follow-up time was 21 months. The median RT dose was 60 Gy and all patients received concomitant TMZ. During follow-up, 41 (83.6%) failures were observed, including 34 (83%) in-field, 4 (9.7%) marginal, and 3 (7.3%) distant failures. Metronomic TMZ was used as salvage treatment in 22 (44%) cases and in combination with local treatment in 12 (24%) cases. The median OS and progression-free survival times for the entire cohort were 17 and 9 months, respectively. In univariate analysis, the following factors were significant for better OS: maximal surgical resection (p=0.03), Karnofsky Performance Score (KPS)>70 at diagnosis (p=0.01), metronomic TMZ treatment (p=0.038), recursive partitioning analysis class III (p=0.03), and time to failure >9 months (p=0.0001). In multivariate analysis, the following factors remained significant for better OS: metronomic TMZ (p=0.01) and time to failure >9 months (p=0.0001). CONCLUSION: The median OS of Brazilian patients with GBM treated with RT and TMZ was satisfactory. Although TMZ therapy has become the standard of care for patients with newly diagnosed GBM, the recurrence rate is extremely high. Metronomic TMZ as salvage treatment improved survival in these patients.

Estudio de frecuencia y asociación de los polimorfismos RS965513 y RS1867277 del gen FOXE1 con el carcinoma papilar de tiroides y su riesgo de recurrencia en población chilena / Frequency and association of the polymorphisms RS965513 and RS1867277 of the FOXE1 gene with papillary thyroid carcinoma and its risk of recurrence in Chilean population

Introducción: El gen FOXE1 (Forkhead box E1) codifica para un factor de transcripción involucrado en la morfogénesis tiroidea. El cáncer papilar de tiroides (CPT) se ha asociado con polimorfismos (SNP) de FOXE1 rs1867277 y rs965513 en población asiática y europea. Nuestro objetivo fue investigar la frecuencia y asociación de SNP rs1867277 y rs965513 con CPT y el riesgo de recurrencia de CPT en sujetos chilenos. Métodos: Se reclutaron sujetos con y sin CPT, se describieron sus características epidemiológicas y la forma de presentación clínica (AJCC VIII y MINSAL 2013). Se aisló ADN de leucocitos periféricos y evaluó ambos SNP mediante PCR-HRM y secuencia. Se compararon las frecuencias alélicas y genotípicas entre casos CPT y controles, y entre pacientes CPT de distintos riesgos de recurrencia. Se compararon frecuencia y se estimó el riesgo con test de Fisher y cálculo de odds-ratio (OR). Resultados: De los 184 sujetos, 156 (85%) eran mujeres, edad 39,3±12,3 años; 90 con CPT y 94 sin CPT 26 (28,9%) pacientes eran de riesgo muy bajo, 45 (50%) bajo, 16 (17,8%) intermedio y 3 (3,3%) alto según MINSAL 2013. En relación a la frecuencia de alelo menor (MAF) calculada en sujetos control y CPT, fue 31,7% y 24,5% (SNP rs965513), y 36,7% y 30,1% 8 (rs1867277), respectivamente (p NS). Tampoco fueron diferentes las MAF calculados y comparados entre pacientes con CPT de riesgo bajo e intermedio/alto. Sin embargo, la combinación de los genotipos rs1867277GG y rs965513AA se asoció a mayor riesgo de CPT. Conclusiones: En pacientes chilenos, se describe una frecuencia MAF de los SNP rs1867277 y rs965513 cercana a un 30%, las cuales no se asocian a CPT ni riesgo de recurrencia, sin embargo, sujetos con una combinación genotípica particular podrían tener mayor riesgo de CPT.

FOXE1 gene (Forkhead E1 box) codes for a transcription factor involved in thyroid morphogenesis. Papillary thyroid cancer (PTC) has been associated with FOXE1 polymorphisms (SNPs) rs1867277 and rs965513 in Asian and European population. Our aim was to investigate the frequency and the association of SNPs rs1867277 and rs965513 with PTC and the risk of recurrence of PTC in Chilean subjects. Methods: We recruited subjects with and without PTC. In those with PTC, their epidemiological characteristics and clinical features presentation are described according to AJCC VIII and MINSAL 2013 scales. Peripheral leukocyte DNA was isolated and both SNPs were evaluated using PCR-HRM and sequencing. Allelic and genotypic frequencies were compared between PTC cases and controls, and between PTC patients with different recurrence risks. Results: Of the 184 subjects, 156 (85%) were women, age 39.3 ± 12.3 years; 94 (51%) without PTC and 90 with PTC (49%): 26 (28.9%) patients had very low, 45 (50%) low, 16 (17.8%) intermediate and 3 (3.3%) high risk of recurence according to MINSAL 2013. Regarding the minor allele frequency (MAF) calculated on control and PTC subjects, was 31.7% and 24.5% (SNP rs965513), and 36.7% and 30.1% (rs1867277), respectively (p NS). In patients with PTC, MAFs were not different between patients with low and intermediate/high risk PTC. However, the combination of rs1867277GG and rs965513AA genotypes were associated with an increased risk of PTC. Conclusions: In Chilean patients, the MAF frequency of SNPs rs1867277 and rs965513 is near 30%, and they are are not associated with PTC or its risk of recurrence. However, subjects with a particular genotypic combination may have an increased risk of PTC.

Recurrence rate of basal cell carcinoma in patients submitted to skin flaps or grafts

Abstract: Background: Basal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking. Objectives: To evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts. Methods: A retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence. Results: Of the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types. Study limitations: Retrospective nature of the study. Conclusion: The present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.

Ovarian sertoli-leydig cell tumors: epidemiological, clinical and prognostic factors / Tumores de células de Sertoli-Leydig ovarianos: fatores epidemiológicos, clínicos e prognósticos

Abstract Objective To describe a series of cases of ovarian Sertoli-Leydig cell tumors (SLCTs). Methods Retrospective review of 12 cases of SLCT treated at the Hospital do Câncer de Barretos, Barretos, state of São Paulo, Brazil, between October 2009 and August 2017. Results The median age of the patients was 31 years old (15-71 years old). A total of 9 patients (75.0%) presented symptoms: 8 (66.7%) presented with abdominal pain, 5 (41.7%) presented with abdominal enlargement, 2 (16.7%) presentedwith virilizing signs, 2 (16.7%) presented with abnormal uterine bleeding, 1 (8.3%) presented with dyspareunia, and 1 (8.3%) presented with weight loss. The median preoperative lactate dehydrogenase (LDH) was 504.5 U/L (138-569 U/L), alpha-fetoprotein (AFP) was 2.0 ng/ml (1.1-11.3 ng/ml), human chorionic gonadotropin (β-hCG) was 0.6 mUI/ml (0.0-2.3 mUI/ml), carcinoembryonic antigen (CEA) was 0.9 ng/ml (0.7-3.4 ng/ml), and cancer antigen 125 (CA-125) was 26.0 U/ml (19.1-147.0 U/ml). All of the tumors were unilateral and surgically treated. Lymphadenectomy was performed in 3 (25.0%) patients, but none of the three patients submitted to lymphadenectomy presented lymph node involvement. In the anatomopathological exam, 1 (8.3%) tumor was well-differentiated, 8 (66.7%) were moderately differentiated, and 3 (25.0%) were poorly differentiated. A total of 5 (55.6%) tumors were solid-cystic, 2 (22.2%) were purely cystic, 1 (11.1%) was cystic with vegetations, and 1 (11.1%) was purely solid, but for 3 patients this information was not available. The median lesion size was 14.2 cm (3.2-23.5 cm). All of the tumors were at stage IA of the 2014 classification of the International Federation ofGynecology andObstetrics (FIGO). A total of 2 (16.7%) patients received adjuvant treatment; 1 of themunderwent 3 cycles of paclitaxel and carboplatin every 21days, and the other underwent 4 cycles of ifosfamide, cisplatin and etoposide every 21 days. None of all of the patients had recurrence, and one death related to complications after surgical staging occurred. Conclusion Abdominal pain was the most frequent presentation. There was no ultrasonographic pattern. All of the SLCTs were at stage IA, and most of them were moderately differentiated. Relapses did not occur, but one death related to the surgical staging occurred.

Resumo Objetivo Descrever uma série de casos de tumores de células de Sertoli-Leydig (TCSLs) ovarianos. Métodos Revisão retrospectiva de 12 casos de TCSL tratados no Hospital de Câncer de Barretos entre outubro de 2009 e agosto de 2017. Resultados A mediana de idade foi 31 anos (15-71 anos). Um total de 9 pacientes (75,0%) apresentaram sintomas: 8 (66,7%) apresentaram dor abdominal, 5 (41,7%) apresentaram aumento abdominal, 2 (16,7%) apresentaram virilização, 2 (16,7%) apresentaram sangramento uterino anormal, 1 (8,3%) apresentou dispareunia, e 1 (8,3%) apresentou emagrecimento. A mediana de desidrogenase láctica (DHL) foi 504,5 U/L (138-569 U/L), alfafetoproteína (AFP) foi 2,0 ng/ml (1,1-11,3 ng/ml), gonadotrofina coriônica humana (β-hCG) foi 0,6 mUI/ml (0,0-2,3 mUI/ml), antígeno carcinoembrionário (CEA) foi 0,9 ng/ml (0,7-3,4) ng/ml, e antígeno cancerígeno 125 (CA-125) foi 26,0 U/ml (19,1-147,0 U/ml), todos pré-operatórios. Todos os tumores foram unilaterais e tratados cirurgicamente. Realizou-se linfadenectomia em 3 (25,0%) pacientes, por em, nenhuma das tr^es apresentou acometimento linfonodal. No exame anatomopatológico, 1 tumor (8,3%) era bem diferenciado, 8 (66,7%) eram moderadamente diferenciados, e 3 (25,0%) eram pouco diferenciados. Um total de 5 (55,6%) tumores eram sólido-císticos, 2 (22,2%) eram puramente císticos, 1 (11,1%) era cístico com vegetações, e 1 (11,1%) era puramente sólido, mas para 3 pacientes estas informações não estavam disponíveis. A mediana da dimensão da lesão foi 14,2 cm (3,2-23,5 cm). Todos os tumores eram estádio IA de acordo com a classificação de 2014 da Federação Internacional de Ginecologia e Obstetrícia (FIGO, na sigla em inglês). Duas (16,7%) pacientes receberam adjuvância; uma realizou 3 ciclos de paclitaxel e carboplatina a cada 21 dias, e a outra 4 ciclos de ifosfamida, cisplatina e etoposide a cada 21 dias. Dentre todas as pacientes, nenhuma apresentou recidiva e houve um óbito relacionado a complicações após estadiamento cirúrgico. Conclusão Dor abdominal foi a apresentação mais frequente. Todos os TCSLs eram estádio IA e a maioria era moderadamente diferenciada. Não ocorreram recidivas, mas ocorreu um óbito relacionado ao estadiamento cirúrgico.

Carcinoma de células escamosas de piel: serie de casos / Carcinoma of squamous cells of skin: series of cases

Resumen Introducción: El cáncer de células escamosas (CCE) es el segundo cáncer de piel más frecuente. Sin embargo, no hay publicaciones en Chile sobre el tema. Objetivo: Investigar características sociodemográficas y clínicas del CCE en la Región de Coquimbo, Chile. Material y Métodos: Serie de casos de pacientes con diagnóstico de CCE de piel tratados en el hospital de Coquimbo, entre enero de 2006 y diciembre de 2015. Criterios de inclusión: diagnóstico histológico definitivo de CCE de piel. Criterio de exclusión: 1.- seguimiento posoperatorio menor de 12 meses; 2.- operado en otro hospital; 3.- sometido a otro tratamiento previo a la cirugía; 4.- metástasis cutáneas de un CCE mucoso; 5.- CCE con metástasis a distancia. Variables independientes: edad, género, localización, tamaño, linfonodos comprometidos, residencia costera-interior. Variables dependientes: recurrencia, factores de recurrencia, letalidad. Análisis estadístico: descriptivo y analítico con el programa SSPS. Resultados: Se registraron 2.202 casos de cáncer de piel, 1.487 basocelular (67,5%), 181 melanomas (8,2%) y 534 CCE (24,2%). 236 pacientes tienen datos completos y constituyen el informe, 153 hombres (64,8%) y 83 mujeres (35,2%). Edad: 75,5 años ± 11,7 (extremos 46-94). La localización es: cabeza 158 casos (66,9%), otras áreas expuestas 47 (20%) y no expuestas 31 (14,1%). En cabeza la localización más frecuente es mejilla 40 casos (25%), frente 29 casos (12,3%). En 119 casos (50,4%) el cáncer se presenta ulcerado y en 117, no ulcerado (49,6%); diámetro del tumor 22 milímetros (rango 3-100 mm). En 10 casos hay linfonodos clínicos (4,2%). En 12 casos (5,9%) se extirpa LNC, 2 positivos. 201 casos presentan bordes histológicos libres (85,2%) y en 35 casos, borde comprometido (14,8%). Tasa de recurrencia local 8,5% (20 casos) y ganglionar 2,1% (5 casos). Recidiva del cáncer se asocia a borde histológico comprometido: P = 0,001, IC 95% 3,12-12,19 y ulceración p = 0,01, OR 4,63; IC 1,59-13,50. Seguimiento de 36 meses (rango 12-228). Letalidad 2,56%. Conclusión: El CCE de piel extirpado precozmente con confirmación histológica de erradicación tiene buen pronóstico.

Introduction: Squamous skin cancer (SSC) is the second most frequent skin cáncer, nevertheless reports about this issue are not published in Chile. Objetive: To investigate social, demographics, and clinic characteristics of SSC in semidesertic Coquimbo Region, Chile. Material and Methods: serie of patients diagnosed and treated in Coquimbo hospital between January 2006 and December 2015. Inclussion criteria: 1.- histopathological confirmation of SSC. Exclusion criteria: 1.- follow up lesser than 12 months; 2.- operated in another hospital; 3.- submitted to another treatment prior to surgery; 4.- skin metastasis of mucous squamous carcinoma; 5.- patients with distant metástasis. Independent variables: age, gender, tumor site, tumor size, clinical lymph nodes, shore or valley residency. Dependent variable: recurrency frecuence, factors of recurrency, letality. Statistical analysis: descriptive and analytical by SSPS program. Results: 2.202 skin cancer cases were registered, 1.487 basal cells carcinoma (67.5%), 181 melanoma (8.2%) and 534 squamous cells carcinoma (24.2%). 236 patients with complete data are included in this report. There were 153 men (64.8%), and 83 women (35.2%). Mean age was 75.5 years old ± 11.7 (range 46-94). Primary site was: head 158 patients (66.9%), other sun exposed areas 47 patients (20%), and non exposed areas 31 patients. Cheek and front were the most frequents head site with 40 cases (25%) and 29 cases (12.3%), respectively. In 119 cases (50.4%) SCC was ulcerated, and 117 cases was not; primary tumor diameter was 22 millimeters (range 3-100). Clinical lymph nodes were primarily positives in 10 patients, (4.2%). In 12 cases with negative lymph nodes, sentinel limph node was resected. 2 were positives. Histological borders were tumor free in 201 patients (85.2%) and, 35 cases (14.8%) had positive histological borders. Local recurrence incidence was 8.5% (20 cases). Limph nodes recurrence was 2.1% (5 cases). Cancer recurrence was associated with histological positive borders P = 0.001, IC 95% 3.12-12.19, and ulcerated tumor p = 0.01, OR 4.63; IC 1.59-13.50. Letality was 2.56%. Mean follow up was 36 months (range 12-228 months). Conclusions: SSC has a good prognosis when primary tumor is resected early, with free histological borders resection.

Riesgo de recurrencia en cáncer diferenciado de tiroides: escala MINSAL / Risk of recurrence in differentiated thyroid cancer

Background: Differentiated thyroid cancer (DTC) is generally associated with a favorable prognosis. Its treatment requires surgery, selective use of radioiodine and levothyroxine, and its intensity must be adjusted to the initial risks of mortality and recurrence. Aim: To validate the risk of recurrence classification developed by the Chilean Ministry of Health in 2013 (MINSAL 2013), and compare it with the American Thyroid Association (ATA) 2009 and 2015 classifications. Material and Methods: Retrospective study of 362 patients with DTC aged 44.3 ± 13.4 years (84% women), treated with total thyroidectomy, selective radioiodine ablation and levothyroxine and followed for a median of 4.2 years (range 2.0-7.8). Risk of recurrence was estimated with MINSAL 2013, ATA 2009 and ATA 2015 classifications, and risk of mortality with 7th and 8th American Joint Committee on Cancer (AJCC)/TNM systems. Clinical data obtained during follow-up were used to detect structural and biochemical persistence/recurrence. Results: A mean dose of 104 ± 48 mCi radioiodine was received by 91% of patients. MINSAL 2013 classified 148 (41%), 144 (40%), 67 (19%) and 3 (1%) patients as very low, low, intermediate and high risk of recurrence, respectively. Forty-five (12.4%) patients had persistence or recurrence during follow-up: 33 structural and 12 biochemical. Rates of persistence/recurrence on each category of MINSAL 2013 were 4.1%, 7.6%, 37.3% and 100%, respectively (p < 0.01). Areas under Receiver Operating Characteristic curves for persistence or recurrence of MINSAL 2013, ATA 2009 and ATA 2015 were 0.77 vs 0.73 vs 0.72, respectively. Conclusions: MINSAL 2013 classifies appropriately DTC patients and estimates correctly their risk of persistence or recurrence.

Eficacia y seguridad de la resección endoscópica en pacientes con pólipos colorrectales no pediculados grandes / Efficacy and safety of endoscopic resection in patients with large non-pedunculated colorectal polyps

Introducción: Los pacientes con pólipos colorrectales no pediculados grandes (PCNP-G) han sido tradicionalmente tratados quirúrgicamente. Los avances en la endoscopía terapéutica permiten que la resección endoscópica de estas lesiones pueda ser considerada como una alternativa a la cirugía. Objetivo: Evaluar la eficacia y seguridad de la resección endoscópica en pacientes con PCNP-G. Materiales y métodos: Cohorte prospectiva multicéntrica. Se incluyeron a todos los pacientes referidos para resección endoscópica de PCNP-G entre enero del 2012 y diciembre del 2015, seguidos hasta agosto del 2016. Se obtuvieron las tasas de resecciones exitosas, de recurrencia y de complicaciones. Se analizaron los factores predictivos asociados a resección no exitosa y a recurrencia. Resultados: Se incluyeron 107 pacientes con 115 PCNP-G. La tasa de resección exitosa fue de 92%. Las complicaciones más comunes fueron el sangrado (8,7%) y la perforación (2,6%). La tasa de recurrencia fue de 7%, todas tratadas endoscópicamente con éxito. Los factores predictivos de resección no exitosa fueron una medida >50 mm de la lesión resecada y la presencia de fibrosis; y el único factor predictivo de recurrencia fue una medida >50 mm del pólipo resecado. Conclusiones: La resección endoscópica de los PCNP-G es altamente eficaz y segura

Introduction: Patients with large non-pedunculated colorectal polyps (L-NPCP) have been traditionally treated with surgery. Advances in therapeutic endoscopy allow endoscopic resection of these lesions and can be considered as an alternative to surgery. Objective: To evaluate the efficacy and safety of endoscopic resection in patients with L-NPCP. Methods: A prospective multicentric cohort. All patients referred for endoscopic resection with L-NPCP between January 2012 and December 2015, followed until August 2016, were included. Rates of successful resection, recurrence and complications were obtained. Predictive factors associated with unsuccessful resection and recurrence were analyzed. Results: 115 L-NPCP in 107 patients were included. The rate of successful resection was 92%. The most common complications were bleeding (8.7%) and perforation (2.6%). The recurrence rate was 7%, all successfully treated with a new endoscopic session. Predictors of unsuccessful resection were a measure >50 mm of the lesion and the presence of fibrosis; and the only predictor of recurrence was a size of the polyp resected >50 mm. Conclusions: Endoscopic resection of L-NPCP is very efficacious and safe

Avaliação do tratamento dos nódulos do hepatocarcinoma nos pacientes em lista de espera para transplante hepático / Evaluation of the treatment of the hepatocarcinoma nodules in the patients in waiting list for liver transplant

RESUMO Objetivo: comparar o resultado do transplante de fígado por hepatocarcinoma em pacientes submetidos ou não ao tratamento loco-regional e downstaging, em relação à sobrevida e risco de recidiva na fila de transplante. Métodos: estudo retrospectivo dos pacientes portadores de hepatocarcinoma submetidos a transplante hepático na região metropolitana de São Paulo, entre janeiro de 2007 e dezembro de 2011, a partir de doador falecido. A amostra foi constituída de 414 pacientes. Destes, 29 foram incluídos na lista por downstaging. Os demais 385 foram submetidos ou não ao tratamento loco-regional. Resultados: as análises dos 414 prontuários demonstraram um predomínio de pacientes do sexo masculino (79,5%) e com média de idade de 56 anos. O tratamento dos nódulos foi realizado em 56,4% dos pacientes em fila de espera para o transplante. O método mais utilizado foi a quimio-embolização (79%). Os pacientes submetidos ao tratamento loco-regional tiveram redução significativa no tamanho do maior nódulo (p<0,001). Não houve diferença estatística entre grupos com e sem tratamento loco-regional (p=0,744) e em relação à mortalidade entre pacientes incluídos no Critério de Milão ou ao downstaging (p=0,494). Conclusões: não houve diferença na sobrevida e ocorrência de recidiva associadas ao tratamento loco-regional. Os pacientes incluídos através do processo de downstaging apresentaram resultados de sobrevida comparáveis àqueles previamente classificados como Critério de Milão/Brasil.

ABSTRACT Objective: to compare the outcome of liver transplantation for hepatocarcinoma in submitted or not to locoregional treatment and downstaging regarding survival and risk of recurrence in transplant waiting list patients. Methods: retrospective study of patients with hepatocarcinoma undergoing liver transplantation in the metropolitan region of São Paulo, between January 2007 and December 2011, from a deceased donor. The sample consisted of 414 patients. Of these, 29 patients were included in the list by downstaging. The other 385 were submitted or not to locoregional treatment. Results: the analysis of 414 medical records showed a predominance of male patients (79.5%) with average age of 56 years. Treatment of the lesions was performed in 56.4% of patients on the waiting list for transplant. The most commonly used method was chemoembolization (79%). The locoregional patients undergoing treatment had a significant reduction in nodule size greater (p<0.001). There was no statistical difference between groups with and without locoregional treatment (p=0.744) and on mortality among patients enrolled in the Milan criteria or downstaging (p=0.494). Conclusion: there was no difference in survival and recurrence rate associated with locoregional treatment. Patients included by downstaging process had comparable survival results to those previously classified as Milan/Brazil criteria.

Prognostic factors for left colectomy for colon cancer: a ten years experience of a single university institution / Fatores prognósticos da colectomia esquerda para câncer de cólon: experiência de dez anos de uma instituição universitária

ABSTRACT Background: Colorectal cancer is the third most common cancer in the world. In Brazil, it is the leading cause of cancer in the gastrointestinal tract. Aim: To evaluate the preoperative, perioperative, and postoperative risk factors for recurrence and overall survival of patients with left colon cancer operated during a ten-year period. Methods: Patients with left colon cancer surgically treated underwent clinical preoperative workout and cancer staging. The following factors were studied: gender, age, tumor location, T stage, lymph node yield, N stage, M stage, histological type, and tumor differentiation. It was analyzed the influence in five-year overall survival. Results: A total of 173 patients underwent left colectomy for colon cancer. There was a slight predominance of male gender with 50.9%. The mean age was 60.8 years old. Fifteen (8.7%) tumors were located at splenic flexure, 126 (72.8%) at sigmoid colon, and 32 (18.5%) at descending colon. The median length of hospital stay was seven days. Mean survival was 47.5 months. At 60 months seven patients (4%) lost follow-up, 38 patients (21.9%) deceased and 135 patients (78%) were alive. Overall survival time was 48 months. Conclusion: Advanced stages (T3-T4, N+ and M+) were the only factors associated with poor long term survival in left colon cancer.

RESUMO Racional: O câncer colorretal é o terceiro câncer mais comum no mundo. No Brasil é a principal causa no trato gastrointestinal. Objetivo: Avaliar os fatores de riscos pré, peri e pós-operatório para recorrência e sobrevida global de pacientes com câncer de cólon esquerdo operado durante um período de dez anos. Métodos: Os pacientes com câncer de cólon esquerdo operados foram retrospectivamente avaliados. Os seguintes fatores foram estudados: gênero, idade, localização do tumor, estádio T, número de linfonodos, estágio N, estágio M, tipo histológico e diferenciação tumoral. Foi analisada a influência desses fatores na sobrevida global de cinco anos. Resultados: 173 pacientes foram submetidos à colectomia para câncer de cólon esquerdo. O gênero masculino predominou com 50,9%. A média de idade foi de 60,8 anos. Quinze (8,7%) tumores foram localizados no ângulo esplênico, 126 (72,8%) no sigmóide e 32 (18,5%) e no descendente. A média do tempo de internação foi de sete dias. A sobrevida média foi de 47,5 meses. Aos 60 meses sete doentes (4%) perderam o seguimento, 38 (21,9%) faleceram e 135 (78%) estavam vivos. O tempo de sobrevida global foi de 48 meses. Conclusão: Os estádios avançados (T3-T4, N e M+) foram os únicos fatores associados à menor sobrevida em longo prazo em câncer de cólon esquerdo.

Immediate reconstruction with autologous fat grafting: influence in breast cancerregional recurrence / Reconstrução imediata com enxerto autólogo de gordura: influência na recorrência local de câncer de mama

ABSTRACT Objective: to evaluate local and systemic recurrence of breast cancer in patients submitted to autologous fat grafting in the immediate reconstruction after conservative surgery for breast cancer. Methods: this is a historical cohort study comparing 167 patients submitted to conservative surgery without reconstruction (conservative surgery group) with 27 patients submitted to conservative treatment with immediate graft reconstruction, following the Coleman's technique (lipofilling group). All patients had invasive carcinoma and were operated by a single surgeon from 2004 to 2011. The postoperative follow-up time was 36 months. Results: the overall incidence of local recurrence was 2.4%. No patient in the lipofilling group had local recurrence during the study period. For systemic recurrence, the rates obtained were 3.7% (one patient) for the fat grafting group and 1.8% (three patients) for the conservative surgery group without reconstruction. Conclusion: there was no significant difference for local or systemic recurrence in the groups studied. Immediate autologous fat grafting appears to be a safe procedure.

RESUMO Objetivo: avaliar recorrência local e sistêmica do câncer de mama em pacientes submetidas ao enxerto autólogo de gordura na reconstrução imediata após cirurgia conservadora para o câncer de mama. Métodos: estudo de coorte histórica em que foram comparadas 167 pacientes submetidas à cirurgia conservadora sem reconstrução com 27 pacientes submetidas ao tratamento conservador com reconstrução imediata do enxerto, seguindo técnica de Coleman. Todas as pacientes eram portadoras de carcinoma invasor e foram operadas por um único cirurgião, no período de 2004 a 2011. O tempo de acompanhamento pós-operatório foi 36 meses. Resultados: a incidência global de recidiva local foi 2,4%. Nenhuma paciente do grupo de lipoenxertia apresentou recorrência local durante o período do estudo. Para recorrência sistêmica, as taxas obtidas foram de 3,7% (uma paciente) para o grupo lipoenxertia e 1,8% (três pacientes) para grupo da cirurgia conservadora sem reconstrução. Conclusão: não houve diferença significativa para recorrência local ou sistêmica nos grupos estudados. O enxerto autólogo imediato de gordura parece ser um procedimento seguro.