RESUMO
Context: The pattern of nodal spread in oral cancers is largely predictable and treatment of neck can be tailored with this knowledge. Most studies available on the pattern are from the western world and for early cancers of the tongue and floor of the mouth. Aims: The present study was aimed to evaluate the prevalence and pattern of nodal metastasis in patients with pathologic T4 (pT4) buccal/alveolar cancers. Settings and Design: Medical records of the patients with pT4 primary buccal and alveolar squamous cell carcinomas treated by single-stage resection of primary tumor and neck dissection at Gujarat Cancer and Research Institute (GCRI), Ahmedabad, a regional cancer center in India, during September 2004 to August 2006, were analyzed for nodal involvement. Materials and Methods: The study included 127 patients with pT4 buccal/alveolar cancer. Data pertaining to clinical nodal status, histologic grade, pT and pN status (TNM classification of malignant tumors, UICC, 6th edition, 2002), total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded. Statistical analysis was performed using the Chi-square test. Results: Fifty percent of the patients did not have nodal metastasis on final histopathology. Occult metastasis rate was 23%. All of these occurred in levels I to III. Among those with clinically palpable nodes, level V involvement was seen only in 4% of the patients with pT4 buccal cancer and 3% of the patients with alveolar cancer. Conclusions: Elective treatment of the neck in the form of selective neck dissection of levels I to III is needed for T4 cancers of gingivobuccal complex due to a high rate of occult metastasis. Selected patients with clinically involved nodes could be well served by a selective neck dissection incorporating levels I to III or IV.
Assuntos
Adenocarcinoma Bronquioloalveolar/patologia , Adenocarcinoma Bronquioloalveolar/fisiopatologia , Adenocarcinoma Bronquioloalveolar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Índia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/epidemiologia , Neoplasias Bucais/patologia , Neoplasias Bucais/fisiopatologia , Neoplasias Bucais/cirurgia , Esvaziamento Cervical , Estadiamento de Neoplasias , Neoplasias de Células Escamosas/epidemiologia , Neoplasias de Células Escamosas/patologia , Neoplasias de Células Escamosas/fisiopatologia , Neoplasias de Células Escamosas/cirurgia , PrevalênciaRESUMO
Um paciente, portador de infecçao hansenica ha 20 anos, e considerado como virchowiano inativo, apresentou nos ultimos 4 anos de vida, dois surtos de reaçao de pseudo-exacerbaçao ( reaçao reversa), o ultimo deles coincidindo com internaçao onde foi diagnosticado um carcinoma bronquiolar dos pulmoes, cujo agravamento ocasionou o obito. Discutem-se as dificuldades do diagnostico clinico diferencial deste tipo de carcinoma pulmonar com outras patologias com caracteristicas clinicas e evolutivas semelhantes, bem como a dificuldade de se chegar a este diagnostico apenas pela analise de uma biopsia pulmonar. Em relaçao as reaçoes de pseudo-exacerbaçao, duas interpretacoes sao postas em confronto, e e salientada a hipotese destas reaçoes se desenvolverem como resposta a surtos de proliferaçao bacilar que poderm ocorrer em pacientes dimorfos em qualquer fase da evoluçao da infecçao, devido a tratamento inadequado ou resistencia medicamentosa...