RESUMO
Introdução: o carcinoma espinocelular constitui a segunda neoplasia de pele mais freqüente e apresenta índice de cura superior a 90%, quando tratado na fase mais inicial. Tumores maiores e uma pequena fração dos tumores iniciais costumam apresentar evolução desfavorável, representada pelas recidivas loco-regional e à distância, apesar do tratamento inicial. Objetivo: Identificar, por análise retrospectiva, os fatores histológicos e clínicos associados à evolução adversa, identificando os tumores de pacientes de alto risco. Pacientes e Método: Foram analisados trinta e cinco prontuários de pacientes submetidos ao tratamento cirúrgico do carcinoma espinocelular (CEC) cutâneo de cabeça e pescoço, sendo coletadas informações sobre espessura (milímetros), invasão perineural, grau de diferenciação e invasão angiolinfática. Realizou-se a análise estatística da associação desses fatores com as variáveis da evolução do CEC (recidiva local, metástase linfática, metástase à distância e óbito por doença). Procedeu-se de forma similar na comparação das variáveis da evolução do CEC entre si. Admitiu-se diferença estatística de 5%. Resultados: Ocorreu associação estatística entre a recidiva local e invasão perineural; metástase linfática e invasão angiolinfática, espessura e invasão perineural; metástase à distância e invasão angiolinfática; óbito e invasão perineural, invasão angiolinfática, espessura tumoral. Entre as variáveis do CEC, verificou-se que a metástase linfática e a metástase à distância estiveram associadas ao óbito. Conclusão: Os fatores histológicos e clínicos observados na evolução permitem definir pacientes de alto risco para os quais o seguimento e novos protocolos terapêuticos prospectivos podem ser mais bem estabelecidos.
Introduction: the squamous cell carcinoma (SCC) is the second most common skin cancer. Most patients with small tumors can be cured at rates that exceed 90%. Larger tumors and a subset of the small ones will present substantial risk of recurrence, despite the correct initial treatment. Objective: to identify through retrospective analysis the histological and clinical features associated with recurrence and metastasis. Materials and methods: The records of 35 patients with SCC of the head and neck skin treated through surgery were reviewed. Information about tumor depth in millimeters, perineural invasion, grade (Broders) and angiolymphatic invasion was analyzed. The statistical association of these factors with selected prognostic variables [local recurrence, lymph node metastasis, distant metastasis and death caused by the disease (DOD)] was reviewed. In a similar fashion, the prognostic variables were compared and analyzed. Statistical significance was admitted at the level of 5%. Results: Statistical significance was found in local recurrence and perineural invasion; lymph node metastasis and perineural invasion; angiolymphatic invasion and depth of infiltration; distant metastasis and angiolymphatic invasion; death and perineural invasion; and depth of infiltration and angiolymphatic invasion. Concerning the prognostic variables we found association between DOD and distant metastasis and between DOD and lymph node metastasis. Conclusion: Histological and clinical factors may help to define high-risk patients with SCC of the head and neck skin. It is suggested identification of high risk group of patients and perhaps new prospective management protocols should be established in these patients.
RESUMO
Context: Parapharyngeal space tumors comprise less than 0.5 per cent of all head and neck neoplasms. The majority of these tumors are benign, but surgery is usually required to establish the diagnosis and treat the patients. We present 26 patients treated surgically for tumors arising in the parapharyngeal space (PPS) at the State University of Campinas Hospital - UNICAMP. Cases Serie: Of these, 17 (65.5 per cent) had benign and 9 (34.6 per cent) malignant neoplasms. The surgical and pathological data relevant to these cases are highlighted, observing any local recurrence, surgical complications and the five-year survival. Neurogenic tumors and soft tissue sarcomas were, respectively, the most frequent benign (35.3 per cent) and malignant neoplasms (44.5 per cent). Benign tumors accounted for the majority of the cases and involved minimal surgical morbidity with no recurrence during a median follow-up of five years. Malignant tumors had a high rate recurrence and mortality. Surgery is the treatment of choice for PPS tumors. A knowledge of the anatomy of this site is essential for the safe performance of surgical procedures. Malignant neoplasms have a poor prognosis. Fine needle aspiration was helpful in diagnosis of all tumors.