Sarcoma fibromixoide de baixo grau em região paratesticular: um relato de caso / Low-grade fibromyxoid sarcoma in paratesticular area: a case report

Objetivos: relatar um caso raro de sarcoma fibromixoide de baixo grau (SFMBG) em uma localização incomum de modo a reforçar aspectos histopatológicos e imunoistoquímicos relevantes para o reconhecimento desta entidade e o adequado diagnóstico diferencial de massas paratesticulares. Relato de caso: homem de 20 anos, com massa escrotal à direita, cuja análise histopatológica demonstrou a presença de tecido fibroso com áreas mixoides e predominância de células fusiformes. A imunoistoquímica foi positiva para vimentina, com índice de Ki67 de 2%, e negativa para S100, CD-34, beta-catenina, desmina e miogenina. Conclusões: caso raro de SFMBG na região paratesticular que reforça a importância da histopatologia e da imunoistoquímica no diagnóstico desse tumor. Apesar da característica histológica benigna, o SFMBG apresenta altas taxas de recorrência e metástases, sendo essencial o seguimento do paciente.

Objectives: to report a rare case of low-grade fibromyxoid sarcoma (LGFMS) in an unusual location in order to reinforce histopathological and immunohistochemical aspects relevant to the recognition of this entity and the adequate differential diagnosis of paratesticular masses. Case report: 20-year-old man, with a right scrotal mass and histopathological analysis showing the presence of fibrous tissue with myxoid areas and a predominance of spindle cells. Immunohistochemistry was positive for vimentin, with a Ki67 index of 2%, and negative for S100, CD-34, beta-catenin, desmin and myogenin. Conclusions: rare case of LGFMS in the paratesticular region that reinforces the importance of histopathology and immunohistochemistry in the diagnosis of this tumor. Despite the benign histological characteristic, LGFMS has high rates of recurrence and metastasis, and patient follow-up is essential.

Malignant uterine neoplasms attended at a brazilian regional hospital: 16-years profile and time elapsed for diagnosis and treatment / Neoplasias malignas do útero atendidas em hospital regional brasileiro: Perfil em 16 Anos e tempo dispendido até diagnóstico e tratamento

Abstract Objective The present study aims to evaluate the profile of endometrial carcinomas and uterine sarcomas attended in a Brazilian cancer center in the period from 2001 to 2016 and to analyze the impact of time elapsed fromsymptoms to diagnoses or treatment in cancer stage and survival. Methods This observational study with 1,190 cases evaluated the year of diagnosis, age-group, cancer stage and histological type. A subgroup of 185 women with endometrioid histology attended in the period from 2012 to 2017 was selected to assess information about initial symptoms, diagnosticmethods, overall survival, and to evaluate the influence of the time elapsed from symptoms to diagnosis and treatment on staging and survival. The statistics used were descriptive, trend test, and the Kaplan- Meier method, with p-values < 0.05 for significance. Results A total of 1,068 (89.7%) carcinomas (77.2% endometrioid and 22.8% nonendometrioid) and 122 (10.3%) sarcomas were analyzed, with an increasing trend in the period (p < 0.05). Histologies of non-endometrioid carcinomas, G3 endometrioid, and carcinosarcomas constituted 30% of the cases. Non-endometrioid carcinomas and sarcomas weremore frequently diagnosed in patients over 70 years of age and those on stage IV (p < 0.05). The endometrioid subgroup with 185 women reported 92% of abnormal uterine bleeding and 43% diagnosis after curettage. The average time elapsed between symptoms to diagnosis was 244 days, and between symptoms to treatment was 376 days, all without association with staging (p = 0.976) and survival (p = 0.160). Only 12% of the patients started treatment up to 60 days after diagnosis. Conclusion The number of uterine carcinoma and sarcoma cases increased over the period of 2001 to 2016. Aggressive histology comprised 30% of the patients and, for endometrioid carcinomas, the time elapsed between symptoms and diagnosis or treatment was long, although without association with staging or survival.

Resumo Objetivo O presente estudo avaliou o perfil dos carcinomas endometriais e sarcomas uterinos atendidos em um centro brasileiro de câncer no período de 2001 a 2016, e avaliou o impacto do tempo decorrido entre os sintomas até o diagnóstico ou tratamento no estadiamento e sobrevida pelo câncer. Métodos Estudo observacional com 1.190 casos que analisou o ano do diagnóstico, faixa etária, estágio e tipo histológico do câncer. Um subgrupo de 185 mulheres com histologia endometrioide e atendidas no período de 2012 a 2017 foi selecionado para avaliar informações sobre sintomas iniciais, métodos de diagnóstico, sobrevida global e para analisar a relação entre o tempo decorrido a partir dos sintomas até o diagnóstico e tratamento no estadiamento e sobrevida. Foram realizadas análises estatísticas descritiva, de tendência linear e de sobrevida pelo método de Kaplan-Meier, com valores de p < 0,05 para significância. Resultados Os casos estudados de acordo com a histologia foram 1.068 (89,7%) carcinomas (77,2% endometrioides e 22,8% não endometrioides) e 122 (10,3%) sarcomas, com tendência crescente no período (p < 0,05). Histologias de carcinomas não endometrioides, G3 endometrioides e carcinossarcomas consistiram em 30% dos casos. Carcinomas não endometrioides e sarcomas forammais frequentemente diagnosticados em pacientes acima de 70 anos de idade e em estágio IV (p < 0,05). O subgrupo com185 mulheres com carcinoma endometrioide apresentou 92% de sangramento uterino anormal e 43% de diagnóstico após curetagem. O tempo médio decorrido entre os sintomas e o diagnóstico foi de 244 dias e entre os sintomas e o tratamento, 376 dias, todos sem associação com estadiamento (p = 0,976) e sobrevida (p = 0,160). Apenas 12% das pacientes iniciaram o tratamento em até 60 dias após o diagnóstico. Conclusão O número de casos de carcinomas e sarcomas uterinos aumentaram no período de 2001 a 2016. A histologia agressiva compreendeu 30% dos pacientes e, no caso dos carcinomas endometrioides, o tempo decorrido entre os sintomas e o diagnóstico ou tratamento foi longo, embora sem associação com estadiamento ou sobrevida.

Adult primary liver sarcoma: systematic review / Sarcoma primário de fígado em adultos: revisão sistemática

ABSTRACT Introduction: primary liver sarcoma is a rare type of tumor, more common in children. Among adults, it represents a spectrum of neoplasms with reserved prognosis. There is no consensus on the treatment of choice of these lesions, justifying a systematic review of the literature on treatment options, prognostic factors, and survival. Material/Methods: a systematic review of articles published in Pubmed, Medline, LiLacs e SciElo, from 1966 to March/2019, presenting the keywords: primary-liver-sarcoma and primary-hepatic-sarcoma was undertaken. Studies including patients older than 18 years, and published in English, Portuguese and Spanish were included. Case reports, metastatic tumors and multiple oncologic diagnosis were excluded. The initial search listed 1,318 articles. 1,206 did not meet the inclusion criteria. After reviewing 112 eligible articles, 15 were selected (14 case series and 1 retrospective-cohort). Results: proposed treatment modalities for primary liver sarcoma included surgery and/or chemotherapy and/or radiotherapy or liver transplantation. The most common histological types were angiosarcoma (32%), leiomyosarcoma (29%), epithelioid hemangioendothelioma (15%) and embryonal sarcoma (7%). Histology, degree of differentiation and R0 resection were mentioned positive prognostic factors. Median survival ranged from two to 23 months. Five-year survival rate varied from 0% to 64%, on average 21%. Conclusion: surgical resection (R0 resection) is the main treatment for primary liver sarcomas. Development of effective systemic therapies are required to improve prognosis of patients harboring this type of tumor.

RESUMO Introdução: o sarcoma primário do fígado é uma neoplasia rara, que acomete mais frequentemente crianças. Nos adultos, representa espectro de neoplasias de prognóstico reservado. Entretanto, em nenhuma faixa etária há consenso sobre a terapêutica de escolha dessas lesões, motivando revisão sistemática com objetivo de elencar opções de tratamento, fatores prognósticos e sobrevida. Material/Método: realizamos revisão sistemática dos artigos publicados nas bases de dados Pubmed, Medline, LiLacs e Scielo, de 1966 a março/2019, contendo as palavras-chaves: primary-liver-sarcoma e primary-hepatic-sarcoma. Foram incluídos estudos que incluíram pacientes com idade a partir de 18 anos e publicados em inglês, português e espanhol. Relatos de caso, tumores metastáticos e pacientes com múltiplos diagnósticos oncológicos foram excluídos. Foram encontrados inicialmente 1.318 artigos, desses, 1.206 foram excluídos por estarem fora dos critérios de inclusão. Dos 112 artigos analisados e discutidos, 15 foram incluídos nesse artigo (14 séries de casos e 1 estudo de coorte retrospectivo). Resultado: os tratamentos propostos para o sarcoma primário do fígado em adultos incluíram cirurgia e/ou quimioterapia e/ou radioterapia ou transplante hepático. Os tipos histológicos mais frequentemente relados foram angiossarcoma (32%), leiomiossarcoma (29%), hemangioendotelioma epitelioide (15%) e sarcoma embrionário (7%). Tipo histológico, grau de diferenciação e resseção R0 foram os principais fatores de bom prognóstico. A sobrevida média total variou de dois a 23 meses. A sobrevida em cinco anos variou entre 0 e 64%, em média 21%. Conclusão: ressecção cirúrgica R0 é a base do tratamento dos sarcomas primários do fígado. Esse grupo heterogêneo de tumores requer desenvolvimento de terapias sistêmicas efetivas para melhoria do prognóstico.

Pleomorphic hyalinizing angiectatic tumor of the mesorectum: a rare case and review of literature

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare tumor of uncertain tissue origin. Although it has been classified as a benign tumor under the WHO classification, it is locally aggressive, and multiple recurrences have been reported. PHAT commonly involves the lower extremities; however, various unusual sites of origin have been reported. We present the case of a 30-year-old female with dysmenorrhea, who presented a presacral mass on imaging. The core biopsy confirmed the diagnosis of PHAT. She underwent laparotomy and excision. Histopathology confirmed the presence of a tumor comprised of aggregates of ectatic vessels with perivascular hyalinization. An immunohistochemical study showed diffuse CD34 positivity, but S100, MDM2, and smooth muscle actin negativity. After surgical procedures, the patient is disease free as at the 12-month follow-up. Only 120 cases have been published in the English literature to date. Our study is only the third case of PHAT arising from the pelvis to be reported. Though considered to be a rare condition, the diagnosis of PHAT should always be considered in the differential diagnosis of well-defined hypervascular soft tissue mass in the pelvis. The typical histopathological findings along with immunohistochemistry should clinch the diagnosis.

Histopathology and immunohistochemistry of peripheral neural sheath tumor and perivascular wall tumor in dog / Histopatologia e imuno-histoquímica de tumor de bainha de nervo periférico e de tumor de parede perivascular em cães

Soft tissue sarcomas (STS) comprise a heterogeneous group of malignancies derived from extra-skeletal mesenchymal tissues that may show similar histopathological changes. Histopathologic patterns suggestive of perivascular wall tumors (PWT) and peripheral nerve sheath tumors (PNST) have been described. This study investigated the histogenesis in a series of 71 cases of canine STS that showed morphological compatibility with what is described for PWT and PNST. Immunohistochemistry analysis were done to CD56, S100, SMA, Desmin, Von Willebrand Factor, NSE and GFAP. Twenty-one cases (29.6%) showed histopathologic features compatible with PWT, 23 cases (32.4%) with PNST and 27 cases (38.0%) shared both histopathological features. By immunohistochemistry, 59 (83.1%) cases showed positivity only for neural markers and 12 (16.9%) had simultaneous positivity for both neural and muscle markers. PNST was the most prevalent neoplasm and none of the cases were positive for muscle markers only. The histopathologic features were not useful to define the diagnosis of PWT, since most tumors were negative for muscle markers but positive for neural markers. Due to this immunoreactivity and the morphologic features, future studies may propose guidelines for the classification of these neoplasms.(AU)

Sarcoma de tecidos moles (STM) compreende um grupo heterogêneo de neoplasias malignas, derivadas de tecidos extraesqueléticos, que podem apresentar alterações histopatológicas similares. Os padrões histopatológicos sugestivos de tumor de parede perivascular (TPP) e de tumor de bainha de nervo periférico (TBNP) têm sido descritos. Este estudo investigou a histogênese de uma série de 71 STM caninos, que apresentavam compatibilidade morfológica com o que é descrito para TPP e TBNP. A análise imuno-histoquímica foi feita para CD56, S100, SMA, Desmina, Fator Von Willebrand, NSE e GFAP. Vinte e um casos (29,6%) apresentaram características histopatológicas compatíveis com TPP, 23 casos (32,4%) com TBNP e 27 casos (38,0%) apresentaram características histopatológicas de ambos. Na imuno-histoquímica, 59 (83,1%) casos apresentaram positividade somente para marcadores neurais e 12 (16,9%) tiveram positividade simultânea tanto para marcadores neurais como para marcadores musculares. TBNP foi a neoplasia mais prevalente e nenhum dos casos foi positivo para somente para marcadores musculares. As características histopatológicas não foram úteis para definir o diagnóstico de TPP, uma vez que a maioria foi negativa para marcadores musculares, mas positiva para marcadores neurais. Devido a essa imunorreatividade e às características morfológicas, pesquisas futuras poderão propor orientações para a classificação dessas neoplasias.(AU)

Tumores hepáticos primarios malignos no hepatocarcinoma ni colangiocarcinoma / Primary malignant hepatic tumors other than hepatocarcinoma or cholangiocarcinoma: a series of cases

Background: There are several types of primary malignant hepatic tumors (PMHT) other than hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC): they are infrequent and poorly known. Imaging studies could help characterize the lesions and may guide the diagnosis. However, the definitive diagnosis of PMHT is made by pathology. Aim: To review a registry of liver biopsies performed to diagnose hepatic tumors. Patients and Methods: Review of a pathology registry of liver biopsies performed for the diagnosis of liver tumors. Among these, 25 patients aged 57 ± 17 years, 60% males, in whom a liver tumor other than a HCC or CC was diagnosed, were selected for review. The medical records of these patients were reviewed to register their clinical characteristics, imaging and the pathological diagnosis performed during surgery and/ or with the percutaneous liver biopsy. Results: Ten patients (40%) had neuroendocrine tumors, six (24%) had a lymphoma and four (16%) had hepatic hemangioendothelioma. Angiosarcoma and sarcomatoid carcinoma were diagnosed in one patient each. In 22 patients (88%), neither clinical features nor imaging studies gave the correct diagnosis. Four patients (16%) had chronic liver disease. The most frequent symptoms were weight loss in 28% and abdominal pain in 24%. Conclusions: The most common PMHT other than HCC and CC were neuroendocrine tumors and lymphomas. Imaging or clinical features were not helpful to reach the correct diagnosis.

Evaluation of incidence and histolopathological findings of soft tissue sarcomas in genitourinary tract: Uludag university experience

ABSTRACT Purpose: In this study we aimed to review urological soft tissue sarcomas of genitourinary tract that were diagnosed in our institution and their prognostic factors for survival. Materials and Methods: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed. Results: The most common site was kidney (17 cases, 54.8%), and most common diagnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Significant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival. Conclusions: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.

Disponibilidad de técnicas moleculares para niños con tumores de difícil caracterización. Un problema en la Oncopatología pediátrica. Aplicación y difusión de técnicas de diagnóstico complementarias en el ámbito público / Availability of molecular techniques for children with difficult-to-characterize tumors. A problem in pediatric oncopathology. Application and diffusion of complementary diagnostic techniques in the public setting

La revolución de la biología molecular y el desarrollo de la investigación biomédica básica para el diagnóstico y posterior manejo del cáncer infantil han llevado a la necesidad de organización de grupos interdisciplinarios de profesionales, los cuales se encargan de afrontar los nuevos desafíos diagnósticos y terapéuticos. Los sarcomas indiferenciados pediátricos constituyen un grupo heterogéneo de neoplasias malignas de aspecto primitivo y polifenotípico. La categorización de gran parte de este tipo de tumores es posible gracias a la aplicación de técnicas moleculares complementarias al estudio histopatológico. El objetivo del presente estudio fue recategorizar sarcomas indiferenciados mediante la implementación de una nueva metodología diagnóstica. Se efectuaron técnicas de inmunohistoquimica (IHQ), FISH de interfase y RT-PCR a partir de tejido fijado en formol e incluido en parafina en 144 casos de sarcomas indiferenciados. Se logró la recategorización del 95.1% de los casos, arribando a 24 diagnósticos diferentes. Sólo un 4.9% permanece aún como sarcoma indiferenciado o inclasificable. Los resultados alcanzados por este estudio demuestran la importancia de contar con nuevas herramientas diagnósticas a nivel molecular y recursos humanos especializados que posibiliten su correcta implementación para el diagnóstico de neoplasias de difícil caracterización (AU)

The revolution of molecular biology and the development of basic medical research for the diagnosis and subsequent management of childhood cancer have led to a need to organize interdisciplinary groups of professionals in charge of facing new diagnostic and treatment challenges. Childhood undifferentiated sarcomas are a heterogeneous group of malignant neoplasms that are primitive in appearance and have polyphenotypic features. Categorization of a large part of this type of tumor has become possible with molecular techniques as a complement to histopathological studies. The aim of this study was to categorize undifferentiated sarcomas using new diagnostic tools. Immunohistochemistry (IHC), interfase FISH, and RT-PCR techniques were used on formalin-fixed and paraffin-embedded tissues of 144 cases of undifferentiated sarcomas. Overall, 95.1% of the cases could be recategorized resulting in 24 different diagnoses. In only 4.9% the diagnosis of undifferentiated or unclassifiable sarcoma was maintained. These results emphasize the importance of the availability of new diagnostic tools at the molecular level and specialized human resources enabling adequate implementation for the diagnosis of difficult-to-characterize neoplasms (AU)

Outcomes after surgical resection of primary non-myxoma cardiac tumors

Abstract Objective: Primary cardiac tumors are rare lesions with different histological type. We reviewed our 17 years of experience in the surgical treatment and clinical results of primary non-myxoma cardiac tumors. Methods: Between July 2000 and February 2017, 21 patients with primary cardiac tumor were surgically treated in our institution. The tumors were categorized as benign non-myxomas and malignants. Data including the demographic characteristics, details of the tumor histology and grading, cardiac medical and surgical history, surgical procedure of the patients were obtained from the hospital database. Results: Eleven patients were diagnosed with benign non-myxoma tumor (male/female:7/4), ranging in age from 10 days to 74 years (mean age 30.9±26.5 years). Papillary fibroelastoma was the most frequent type (63.6%). There were two early deaths in benign group (all were rhabdomyoma), and mortality rate was 18%. The mean follow-up period was 69.3±58.7 months (range, 3 to 178 months). All survivals in benign group were free of tumor-related symptoms and tumor relapses. Ten patients were diagnosed with malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from 14 years to 73 years (mean age 44.7±18.9 years). Total resection could be done in only three (30%) patients. The mean follow-up period was 18.7±24.8 months (range, 0-78 months). Six patients died in the first 10 months. Conclusion: Complete resection of the cardiac tumors, whenever possible, is the main goal of surgery. Surgical resection of benign cardiac tumors is safe, usually curative and provides excellent long-term prognosis. On the contrary, malignant cardiac tumors still remain highly lethal.

Sarcoma diseminado de células dendríticas interdigitantes / Disseminated interdigitating dendritic cell sarcoma

Se describe el caso de una mujer de 70 años que consultó por dolor abdominal asociado a pérdida de peso y sudoración nocturna. En el examen físico se destacaban una masa abdominal comprendida entre el epigastrio y el flanco izquierdo, de unos 5 cm de diámetro, duro-elástica, móvil e indolora, y al menos tres adenopatías supraclaviculares bilaterales de 2 cm de diámetro, duras y adheridas a planos profundos. Se realizó una biopsia de la masa abdominal, con lo que se diagnosticó un sarcoma de células dendríticas interdigitantes. Se inició quimioterapia con el esquema CHOP (ciclofosfamida, doxorrubicina, vincristina y prednisona). Falleció luego de completado el primer ciclo del tratamiento, a los seis meses del diagnóstico.

A 70 year-old woman was admitted to our hospital with a 3-month history of abdominal pain, weight loss and night sweats. On physical examination, she presented with a 5 cm diameter abdominal mass extended from epigastrium to the left flank, and at least three bilateral supraclavicular adenopathies. A disseminated interdigitating dendritic cell sarcoma was diagnosed through a biopsy of the abdominal mass. After that, a CHOP regime (cyclophosphamide, doxorubicin, vincristine and prednisone) was iniciated. She died after completion of the first cycle of treatment, six months after diagnosis.

Reconstrucción funcional y estética del codo (a propósito de un caso) / Functional and aesthetic reconstruction of the elbow (apropos of a case)

La reconstrucción de la región periolécranon es compleja, ya que requiere tejidos que tengan suficiente elasticidad y resistencia y que permitan una rápida recuperación. Cuando la etiología es tumoral, se debe tener en cuenta la exéresis completa de la lesión, la conservación de la funcionalidad del miembro y el aspecto estético, respetando ese orden. Presentamos la evolución de una paciente con un sarcoma de partes blandas en la región del codo que, tras su extirpación en bloque, se reconstruyó con un colgajo pediculado braquial lateral de flujo inverso, y que posteriormente, para mejorar su aspecto estético, se realizó lipoaspiración del colgajo y relleno graso de la zona dadora

The reconstruction of the peri-olecranon region is complex, requiring tissues with enough elasticity and strength, to ensure a rapid recovery. When the etiology is tumoral, complete excision of the lesion, the mobility of the limb, and the aesthetics should be taken into account, in that order. We present the evolution of a patient with soft tissue sarcoma in the elbow region, which was removed, and the elbow was reconstructed with a lateral brachial pedicle flap withreverse flow. Afterwards, to improve their aesthetic appearance, liposuction of the flap was performed, filling the donor site with fat.

Male urethral sarcoma: a case report and literature review / Sarcoma de uretra masculina: relato de caso e revisão de literatura

Urethral tumors are rare and aggressive. They usually affect men (2:1) and occur more commonly in white (85% of cases). Soft tissue sarcomas are a heterogeneous group of tumors that arise from embryonic mesoderm. It represents 1% of all cases of urinary tract malignancies and rarely primary affect the ureter. We report a case of male urethral sarcoma. To date, only two similar cases have been published in literature.

Os tumores de uretra são muito raros e bastante agressivos. Acometem mais frequentemente homens (2:1) e são mais comuns na raça branca (85% dos casos). Os sarcomas de tecidos moles são um grupo heterogêneo de tumores que surgem a partir da mesoderme embrionária e representam 1% de todos os casos de doença maligna urinária, raramente acometendo a uretra primariamente. Relamos aqui um caso extremamente raro de sarcoma uretral masculino com somente dois semelhantes publicados na literatura.

Sarcoma pleomórfico gigante de la mama / Giant pleomorphic breast sarcoma

Abstract It is reported the case of a female patient 50 years old who, after failed attempts at diagnosis, arrives at breast surgery service of the E.S.E. Hospital Universitario del Caribe with history of five months consistent inthe excessive growth of a mass in right breast; patient received radical mastectomy plus reconstruction withlatissimus dorsi muscle flap. Following excision of tumor mass of 6,500 g is performed immunohistochemicaldiagnosis of a giant pleomorphic sarcoma.

Resumen introducción: Los tumores derivados del tejido conectivo interlobulillar de la mama son en mayor proporción malignos y, en virtud a su ubicación, en la actualidad reciben el nombre de "sarcomas" de la mama. Caso clínico: Se reporta el caso de una paciente femenina de 50 años de edad quien, posterior a fallidosintentos de diagnóstico, acude al servicio de cirugía de mama de la E.S.E. Hospital Universitario del Caribecon un cuadro de cinco meses de evolución consistente en el crecimiento desmedido de una masa en mamaderecha; la paciente recibió mastectomía radical más reconstrucción con colgajo de músculo dorsal ancho.Posterior a exéresis de masa tumoral de 6.500 g de peso se lleva a cabo diagnóstico inmunohistoquímico deun sarcoma pleomórfico gigante de la mama.

Perfurador baseado em transposição de retalho estenocelidomastoide para defeitos da região posterior do pescoço: uma nova alternativa / Perforator based sternocleidomastoid transposition flap for nape of neck defect: a novel option

Retalhos do músculo esternocleidomastoideo têm sido descritos na literatura para reconstrução dos defeitos da cavidade oral e tratamento da síndrome de Frey. Apesar de largamente estudado, esses retalhos não são utilizados com frequência para reconstruções na região de cabeça e pescoço devido limitações como tamanho reduzido, camadas inseguras, contorno da deformidade no pescoço e questões de segurança oncológica. Relata-se uso de perfurador baseado em transposição de retalho para defeito na região da posterior do pescoço, seguido por excisão de sarcoma de partes moles. Trata-se de alternativa válida para procedimentos de reconstrução como retalhos regionais de pedículo ou transferência de tecido livre em um grupo apropriado de pacientes.

Sternocleidomastoid musculocutaneous flaps have been described in the literature for reconstruction of oral cavity defects and treatment of Frey's syndrome. Although widely studied, it is not used routinely in head and neck reconstruction due to limitations like small size, unreliable skin paddle, contour deformity in the neck and the question of oncologic safety. We report use of perforator based musculocutaneous transposition flap for defect over nape of the neck, followed by excision of a soft tissue sarcoma. This constitutes a valid alternative to other reconstructive procedures like pedicled regional flaps or free tissue transfer in a suitable group of patients.

Sarcoma Pleomórfico Indiferenciado de Maxilar de Alto Grado: Diagnóstico, Tratamiento y Pronóstico / Undifferentiated Pleomorphic Sarcoma of the Maxillary: Diagnosis, Treatment and Prognosis

Los sarcomas son neoplasias poco vistas en el territorio maxilofacial, donde la baja frecuencia de casos y los cambios de nomenclatura, han dificultado su estudio. Una de las variables de este tipo de lesiones corresponde a un tumor conocido como sarcoma pleomórfico indiferenciado, del cual se sabe muy poco pues se describe una incidencia de 1:1.000.000. Corresponde a un tumor maligno con características clínicas e imagenológicas de crecimiento invasivo y destructivo; la confirmación diagnóstica se realiza por medio de una biopsia en base al estudio histológico e inmunohistoquímico. Aparece principalmente en el tracto nasosinusal y su manejo terapéutico se basa en la cirugía con amplios márgenes de seguridad y radioterapia o quimioterapia según corresponda. No presenta metástasis locales pero si a distancia con gran afinidad por el pulmón. Se reporta un caso de sarcoma pleomórfico indiferenciado de alto grado de maxilar diagnosticado en la Unidad de Patología Oral y Maxilofacial del Hospital las Higueras de Talcahuano durante el año 2014, que a diferencia de la mayoría de los casos reportados, producto de su extensión, fue tratado con radioterapia paliativa. Además, se realizó una revisión de la literatura disponible en diversas bases de datos con lo cual se obtuvo información de casos ya reportados. Actualmente resulta difícil producto de la baja cantidad de casos descritos poder hacer proyecciones en cuanto a su pronóstico o evolución, sin embargo hay consenso de que el manejo interdisciplinario, diagnóstico precoz y la confirmación de este por medio de exámenes complementarios son fundamentales para su adecuado tratamiento.

Sarcomas are neoplastic lesions rarely observed in the maxillofacial region. Due to the few cases reported and to changes in nomenclature of these tumors their study has been difficult. One of the variants of this kind of lesion corresponds to a tumor currently known as undifferentiated pleomorphic sarcoma, which there is scarce knowledge of. In fact the incidence described is about 1:1.000.000. This one corresponds to a malignant tumor with image and clinical features as invasive and destructive growth, the confirmation of diagnosis is carried out by performing biopsy based on histologic and immunohistochemical studies. They appear mostly in the nose and sinusal tract. Its therapeutic management is based on surgery with wide security margins and radio or chemotherapy when warranted. No local metastases but distant ones are found and highly affined with lungs. We report a case of an advanced undifferentiated pleomorphic sarcoma diagnosed at the Oral and maxillofacial pathology unit of Hospital Las Higueras in Talcahuano at 2014, which in spite of most of the reported cases in literature; because of the extent it was treated with palliative radiotherapy. Also has been made review of the available literature in different databases with which information of the reported cases was obtained. Nowadays, due to the low number of cases described it is difficult to establish projections in terms of prognosis or evolution. However, there is consensus that interdisciplinary management, early diagnosis and confirmation with complementary exams are essential for an appropriate treatment.