Factors predicting 'time to distant metastasis' in radically treated head and neck cancer.

Context: Various studies have shown the important risk factors for distant metastasis in head and neck cancer (HNC) which are present in most of the patients in developing countries. Identification of factors on the basis of time to distant metastasis (TDM) can help in future trials targeting smaller subgroups. Aims and Objectives: To identify the factors that predict TDM in radically treated HNC patients. Settings and Design: Retrospective audit. Materials and Methods: Retrospective audit of the prospectively maintained electronic database of a single HNC radiotherapy clinic from 1990 to 2010 was done to identify radically treated patients of HNC who developed distant metastasis. Univariate and multivariate analysis were done to identify baseline (demographic, clinical, pathological, and treatment) factors which could predict TDM, early time to metastasis (ETM; <12 months), intermediate time to metastasis (ITM; 12-24 months), and late time to metastasis (LTM; >2 years) using Kaplan Meier and Cox regression analysis, respectively. Results: One hundred patients with distant metastasis were identified with a median TDM of 7.4 months; 66 had ETM, 17 had ITM, and 17 had LTM. On multivariate analysis, the nodal stage 2-3 (N2/3) was the only baseline factor independently predicting TDM, ETM, and ITM, whereas none of the baseline factors predicted LTM. Conclusions: Higher nodal burden (N2/3) is associated with both ETM and ITM, and calls for aggressive screening, systemic therapy options, and surveillance. It is difficult to predict patients who are at a risk of developing LTM with baseline factors alone and evaluation of biological data is needed.

Comparative study of various grading systems in oral squamous cell carcinoma and their value in predicting lymph node metastasis.

Background: Regional lymph node (LN) metastasis is the single most prognostic factor for oral squamous cell carcinoma (OSCC). An analysis of the prognostic factors is important for predicting prognosis and reducing the mortality in these patients. Objectives: (1) To compare the value of various grading systems in predicting LN metastasis. (2) To evaluate histopathological parameters, which could help in predicting LN metastasis. Materials and Methods: A total of 20 excisional biopsies of OSCCs, were graded according to the four grading systems that is, Broder’s, Jakobsson's, Anneroth and Hansen’s, and Brynes. We also evaluated various histopathological parameters, which could help in predicting LN metastasis. Results: Grading at the invasive front was most prognostic of LN metastasis. Tumors with total malignancy score ≥8 showed higher incidence of metastases. Conclusion: The histopathological parameters that could help in predicting lymph node metastases (LNM) are keratinization, nuclear pleomorphism (NP), and the pattern of invasion (POI) when assessed at the invasive front. When the whole tumor was considered, histopathological parameters like NP and POI were significant in predicting LNM.

Hemangiopericitoma com metástase craniana; relato de caso e análise de literatura / Hemangiopericytoma associated with cranial metastasis; a case report and analysis of the literature

Hemangiopericitomas säo tumores derivados dos pericitos - células presentes nas paredes dos capilares normais - e podem acometer todo o organismo. Quando intracranianos, provêm das meninges e säo considerados raros nessa localizaçäo. Apesar de alguns autores ainda o considerarem variante angioblástica do nemingeoma, o consenso da literatura, baseada em estudos imuno-histoquímicos e ultra-estruturais, é de que se trata de entidade distinta. Pela raridade em nosso meio é apresentado um caso de hemangiopericitoma clavicular com metástase craniana, e discutem-se os aspectos neuro-radiológicos e histopatológicos, relacionados à literatura mundial. Em nossa opiniäo, o hemangiopericitoma é uma entidade distinta. O estudo angiográfico mostrou-se mais útil que o estudo por tomografia computadorizada, permitindo o diagnóstico pré-operatório e auxiliando no planejamento cirúrgico. A ressecçäo desses tumores, invasivos e com alta taxa de metastatizaçäo e reincidência, deve ser total, näo havendo ainda consenso sobre o valor da complementaçäo radioterápica