Nova classificação da OMS para tumores odontogênicos: o que mudou? / Updated WHO classification for odontogenic tumors: what has changed?

Objetivo: apresentar e discutir as mais relevantes modificaçõesna quarta classificação de tumores de cabeçae pescoço da Organização Mundial de Saúde (OMS),no ano de 2017, especialmente para os tumores odontogênicos.Revisão de literatura: o trabalho baseia-seem uma revisão da literatura relacionada ao tema, emespecial no artigo publicado pelos professores John M.Wright e Marilena Vered no Head & Neck PathologyJournal, no ano de 2017, o qual apresenta as principaisatualizações desde as reuniões de 1992 e 2005. O quefoi excluído da terceira edição, o que foi retomado dasegunda edição, as novas descobertas e o porquê detais mudanças serão alguns pontos abordados. Consideraçõesfinais: observa-se que as atualizações foramorientadas pelos princípios de simplicidade, relevânciaclínica, validade científica e utilidade, no intuito defornecer uma classificação contemporânea e menoscomplexa, servindo como base para o clínico e o patologistaem termos de diagnóstico e condução dos casos. (AU)

Objective: this study aimed to present and discuss the most relevant updates in the 4th classification of head and neck tumors by the World Health Organization (WHO) in 2017, especially for odontogenic tumors. Literature review: the study is based on a literature review related to the topic, particularly on the article published by Professors John M. Wright and Marilena Vered in the Head & Neck Pathology Journal in 2017, which presents the main updates since the meetings of 1992 and 2005. What was excluded from the third edition and resumed from the second one, the new findings and the reason for such changes will be some of the points addressed. Final considerations: it is observed that the updates were guided by the principles of simplicity, clinical significance, and scientific validity and utility, in order to provide a contemporary and simpler classification that works as a basis for practitioners and pathologists in terms of diagnosis and management of cases. (AU)

What does the 4th edition of the World Health Organization Classification of Head and Neck Tumors (2017) bring new about mucosal melanomas?

Abstract: The recently published 4th Edition of the World Health Organization Classification of Head and Neck Tumors addresses the most relevant and updated aspects of tumor biology, including clinical presentation, histopathology, immunohistochemistry, and prognosis of head and neck tumors. The objective of the present study is to compare these updates to the 3rd edition of that book with regard to mucosal melanomas and to highlight the potential factors that differ those tumors from cutaneous melanomas. We observed progress in the understanding of oral and sinonasal mucosal melanomas, which also present themselves, in the molecular scope, differently form cutaneous melanomas.

Carcinomas de cabeza y cuello, experiencia de un centro oncológico del estado de Durango, México / Head and neck carcinomas, experience of a cancer center in the state of Durango, Mexico

Antecedentes: los carcinomas de cabeza y cuello son relativamente frecuentes, presentan diversos tipos histológicos y características clínicas, mismas que se asocian con una variedad de riesgos de mortalidad. Objetivo: El propósito de este trabajo fue examinar en un periodo de cinco años carcinomas de cabeza y cuello tratados en el Centro Estatal de Cancerología. Material y métodos: Este estudio se realizó de manera retrospectiva, se revisaron factores de riesgo y tratamientos, se hicieron análisis univariados y multivariados para evaluar factores pronóstico y supervivencia. Resultados: Se obtuvieron un total de 32 expedientes que cumplían con las características del estudio, el periodo de seguimiento fue de 2 a 32 meses. La variante histológica predominante fue carcinoma epidermoide, el tratamiento primario más común fue cirugía. Conclusiones: La supervivencia en los carcinomas de cabeza y cuello disminuye en pacientes en etapas clínicas avanzadas, edad e historia de tabaquismo y/o alcoholismo, la mayoría de ellos muere por progresión de enfermedad y metástasis.

Introduction: carcinomas of the head and neck are relatively common.They include diff erent histological types and present a rangeof clinical characteristics, and are associated with diverse risks of mortality. Objective: To perform a casuistic review of cases of head andneck carcinomas over a period of fi ve years at a State Cancer Center.Material and method: A retrospective study was conducted, in whichrisk factors and treatments were analyzed. Univariate and multivariatestatistical analyses were performed for the purpose of evaluatingprognostic and survival factors. Results: A total of 32 fi les were foundto meet the criteria required by the study. Patient follow-up ranged from2 to 32 months. The predominant histological variant identifi ed wasthe squamous cell carcinoma, while the most common primary treatment was surgery. Conclusions: This study shows that survival fromhead and neck carcinomas decreases in patients who are in advancedclinical stages, particularly those of a certain age with a history ofsmoking and/or alcohol use, most of whom die from the progression and metastasis of the disease.

Características nosológicas de clientes com câncer em cuidados paliativos: autorrelato através da consulta de enfermagem / Nosological characteristics of clients with cancer in palliative care: self-report through the nursing appointment / Caracteristicas nosológicas de clientes con cáncer en cuidados paliativos: autorelato a través de la consulta de enfermería

Este trabalho identificou as características nosológicas de clientes com câncer de cabeça e pescoço em cuidados paliativos. Método descritivo, através da consulta de enfermagem com 77 clientes do Instituto Nacional de Câncer, do Rio de Janeiro, no período de março a agosto de 2011. Entre os clientes, possuem lesão tumoral – 71,43%, inodora – 81,82%, predominando o estágio 0 em 28.57%, situado na cavidade oral – 24,69% e com metástase local – 40,26%. Quanto à capacidade para o autocuidado, a maioria se veste, se alimenta e se locomove sem auxílio e a minoria realiza seu curativo. Concluiu-se que esses clientes despertam atenção, têm problemas familiares e sociais e de autoimagem alterada por desenvolverem, com o avanço da doença, lesões tumorais expostas e com odor fétido. Essas pessoas utilizam dispositivos para alimentação e ventilação artificial, fato incomum no ambiente fora do hospital. Então, há necessidade da orientação de enfermagem sobre os cuidados em domicílio e fortalecimento da autoestima.

This study identified nosological characteristics of clients with head and neck neoplasms in palliative treatment. The method was descriptive, through nursing appointments with 77 clients at the National Cancer Institute, Rio de Janeiro, Brazil, from March to August 2011. Of the clients, 71.43% had tumor lesions, 81.82% odorless, predominantly at stage 0 (28.57%), 24.69% in the oral cavity and 40.26% with local metastasis. As for self-care capacity, most dressed and fed themselves and moved around without assistance, and a minority applied their own dressings. In conclusion, these clients inspire care, have family and social issues, and altered self-image because, as the condition progresses, they develop exposed tumor lesions and foul odor. These individuals use feeding and artificial ventilation devices, which is uncommon outside the hospital environment. There is thus a need for nursing guidance on home care and to strengthen self-esteem.

Este trabajo identificó las características nosológicas de clientes con cáncer de cabeza y cuello en cuidados paliativos. Investigación descriptiva, a través de la consulta de enfermería con 77 enfermos del Instituto Nacional de Cáncer, de Rio de Janeiro-Brasil, de marzo a agosto de 2011. Entre los enfermos, poseen lesión tumoral – 71,43%, inodora – 81,82%, predominando la etapa 0 en 28.57%, situado en la cavidad oral 24,69% y con metástase local – 40,26%. Cuanto a la capacidad para el autocuidado, la mayoria se veste, se alimenta y se locomove sin ayuda y la minoría realiza su curativo. Se concluyó que eses enfermos despiertan atención, tienen problemas familiares y sociales y de autoimagen alterada. Eso és por que desarrollan, con el avanço de la enfermedad, lesiones tumorais, que se quedan expuestas y con odor fétido. Esas personas utilizan dispositivos para alimentación y ventilación artificial, un hecho incomún en el ambiente fuera del hospital. Así, hay necesidad de la orientación de enfermería acerca de los cuidados en domicílio y fortalecimiento de la autoestima.

Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps

To assess the improvement in Quality Of Life [QOL] after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction. Quasi-experimental. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007 A total of 44 patients with locally advanced stage III and IV malignancy of head and neck were included in the study. All patients were treated with ablative surgery and reconstruction with microvascular free flaps. QOL was assessed by using a scoring questionnaire [including 5 parameters for extra oral cancers including physical and role function, body image, weight loss score and pain donor site morbidity; and an additional 5 parameters for intraoral tumours that included swallowing, speech, drooling of saliva and mouth opening]. A high score indicated a poor QOL. Patients were assessed pre-operatively and then at 2, 4 and 6 months postoperatively. Mean accumulative score and mean individual parameter scores for both extra- and intraoral tumours were significantly improved [p < 0.05]. Microvascular free flap reconstruction after ablative surgery in locally advanced head and neck malignancy had a profound impact on the improvement of QOL. There was an initial deterioration of physical scores postoperatively and postradiotherapy, followed by gradual improvement. By the end of 6 months, it surpassed the pre-operative QOL scores

Classificações histopatológicas para o carcinoma de células escamosas da cavidade oral: revisão de sistemas propostos / Histological classifications of oral squamous cell carcinoma: a review of the proposed systems

O sistema de estadiamento clínico de tumores TNM tem sido a classificação adotada para caracterizar os tumores, propor a terapia mais adequada e estimar a sobrevida dos pacientes. As informações obtidas através dos exames clínico e de imagem são utilizadas para estabelecer o estádio clínico (cTNM) e, caso o paciente seja submetido à cirurgia, determina-se o estádio patológico (pTNM) mediante o exame histopatológico do tumor e dos linfonodos regionais. Entretanto tumores clinicamente precoces, mesmo tratados adequadamente, podem causar a morte do paciente. Assim, classificações histopatológicas para os carcinomas de células escamosas (CCE) de cavidade oral surgiram na tentativa de explicar o comportamento biológico discrepante dos tumores. Broders, em 1920, propôs uma gradação histopatológica baseada no grau de diferenciação celular. Contudo muitos autores questionam o valor dessa classificação e o da proposta pela Organização Mundial de Saúde (OMS), destacando o papel de outras características histopatológicas no comportamento biológico do CCE de cavidade oral e propondo novas gradações. Neste sentido, as classificações histopatológicas podem prover fatores prognósticos suplementares, a fim de otimizar o valor do estadiamento TNM e auxiliar na escolha terapêutica. Este estudo visa a apresentar os critérios adotados em algumas classificações histopatológicas para o CCE de cavidade oral, amplamente usadas na literatura científica, discutir suas características, ressaltando suas similaridades e discordâncias, além de analisar sua associação com o desfecho do paciente.

Head and neck squamous cell carcinoma (HNSCC) 5 year study at BSMMU.

Head and Neck Squamous Cell Carcinoma (HNSCC) are generally similar in their clinical features, epidemiology and etiology although their natural and clinical history and treatment differ. Despite lot of improvement in diagnostic and management technique, there is little improvement in survival rate over the last few decades. This study was carried-out in a multidisciplinary tertiary level hospital (BSMMU), with a country-wide catchment area to see the burden of HNSCC existing in our country and their clinical pattern. The overall incidence rate of HNSCC in this study was (0.15%) i.e. 150 person in 1,00,000 population. Male incidence (0.19%) was higher than female (0.12%). This study revealed that carcinoma of the larynx (25.22%) and pyriform fossae (20.57%) were the main culprit, whereas buccal carcinoma was the main component (37.70%) in the female series. Highest incidence was found in the 6th decade in both sexes. As the treatment of HNSCC may be time consuming, requires multidisciplinary approach, demands lot of clinical, social and financial consideration, therefore, the best treatment can be offered through a combined board consisting of Surgical, Radiation, Medical oncologists, Histopathologist and Speech therapist as required.

Extranodal malignant lymphoma of the upperaerodigestive tract in King Chulalongkorn Memorial Hospital according to WHO classification.

BACKGROUND: The Working Formulation commonly used to classify NHL in Thailand has been recognized as imperfect for primary extranodal lymphoma, especially in head and neck regions. OBJECTIVE: To study the clinicopathological and immunohistochemical features of extranodal malignant lymphoma of the upper aerodigestive tract according to WHO classification. SETTING: King Chulalongkorn Memorial Hospital. DESIGN: Descriptive study. PATIENTS: 77 Thai patients who presented between 1998 and 2003. METHODS: Routine histology was performed and stained with H&E and immunohistochemistry, and clinical characteristics were recorded. RESULTS: The patients included 42 males and 35 females, with an average age of 53.87 years. Tumor sites were as follows: Waldeyer ring (n = 42, 54.55%), sinonasal areas (n = 19, 24.67%), oral cavity (n = 9, 11.69%), hypopharynx (n = 4, 5.19%), and larynx (n = 3, 3.90%). Immunohistochemically, 57 tumors (74.02%) were of B-cell phenotype and 19 tumors (24.68%) were of T-cell phenotype. According to the WHO classification, 45 cases (58.43%) were large B-cell, 3 (3.90%) were Burkitt, 3 (3.90%) were marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT), 4 (5.19%) were follicular lymphoma, 1 (1.30%) was precursor B-lymphoblastic lymphoma, and 1 (1.30%) were mantle cell lymphoma. Among the T-cell lymphomas, 9 (11.69%) were of peripheral T-cell lymphoma, unspecified, 9 (11.69%) were extranodal NK/T cell lymphoma, nasal type, and 1 (1.30%) were anaplastic large-cell lymphomas. In nasal cavity, 8 tumors (42.11%) were extranodal NK/T-cell lymphoma, nasal type, 5 (26.32%) were diffuse large B-cell lymphoma, 4 (21.05%) were peripheral T-cell lymphoma, unclassified, and 1 (5.26%) was Burkitt lymphoma. CONCLUSION: Our data correspond with series from Japan, Hong Kong, and Korea, but there is a significant difference from Western population in T-cell lymphomas of sinonasal area especially extranodal NK/T cell lymphoma of nasal type and peripheral T-cell lymphoma, unspecified which had a higher frequency in Thailand, Japan, Hong Kong, and Korea.

Cancers of the Upper Aerodigestive Tract in Korea

Cancers of the upper aerodigestive tract (UADT) constitute 3.5-4% of all malignancies. Since the majority of cases are squamous cell carcinomas which are related with epidemiologic factors, a different pattern of UADT cancer might be present between the Western and Asian populations. We performed a pathology based statistical study on UADT cancers in Korean patients. Cases from Korea Cancer Center Hospital, from January 1, 1988 through December 31, 1998, were subjected to the study. Among 2,842 cases, epithelial malignancies accounted for 87.8%, with squamous cell carcinoma as the major type (76.5%). The larynx was the most commonly affected site (26%), followed by the oral cavity (25.1%), oropharynx (13%), nasopharynx (9%), hypopharynx (8.4%), paranasal sinuses (6.4%), nasal cavity (6%) and salivary glands (6.1%). The percentage of squamous cell carcinoma was highest (98.7%) at the hypopharynx, and lowest at the nasal cavity (42.3%), which showed the most diverse tumor entities. Korean patients with UADT cancers presented with a higher incidence of non-epidermoid malignancy including sarcoma (1.5%) and malignant melanoma (1.4%), and a higher frequency of involvement of the sinonasal tract, compared with the Western patients.

Clasificación de masas cervicales diagnosticadas en niños menores de 15 años / Classification of cervical masses diagnosed in children below 15 years old

Se realizó un estudio de tipo prospectivo y descriptivo, en el cual se analizaron 30 casos de niños con diagnóstico de masa cervical pertenecientes al Hospital Dr. Robert Reid Cabral, Santo Domingo, República Dominicana, en edades comprendidas entre 0-15 años, durante el período de marzo a julio 1991. Donde encontramos que el sexo más afectado fue el masculino, el grupo etario más frecuente era el comprendido entre 0-4 años, y la localización topográfica de mayor incidencia lo fue la región lateral del cuello con un 53

Factores pronósticos en el cáncer de cabeza y cuello / Prognostic factors in head and neck cancer

Se recopilan las experiencias y resultados publicados en la literatura médica sobre los tumores de cabeza y cuello, basados en factores pronósticos, que permiten el surgimiento de la terapéutica electiva antineoplásica en la enfermedad subclínica y la utilización de terapia médica inductiva y adyuvante. Debido a su mayor accesibilidad al clínico, el territorio de cabeza y cuello permite la mejor identificación de los factores pronósticos relacionados con paciente, tumor e interacción de ambos. Se analizan localización, etapa clínica, espesor tumoral, grado nuclear y grado de queratinización, número de mitosis, respuesta inflamatoria y desmoplásica, patrón de invasión vascular y perineural. Las modificaciones de algunos esquemas y momentos terapéuticos tradicionales se basan en los factores pronósticos de los tumores. Esto ha permitido incrementar el tiempo libre de enfermedad, disminuir la frecuencia de recurrencias locales y de metástasis y mejorar la calidad de vida y la supervivencia

Abordagem do paciente com massa cervical / Approach to the patient with neck mass

Na pratica clinica e muito frequente o medico deparar-se com um paciente que apresenta uma massa cervical. Esta pode representar varias patologias, primarias ou secundarias, de etiologia variada: congenita, inflamatoria, traumatica ou neoplasica. Uma abordagem criteriosa deste paciente, incluindo uma anamnese completa, um exame fisico detalhado e uma solicitacao pertinente de exames complementares, geralmente permite o estabelecimento do diagnostico. Quando necessaria, a biopsia da massa cervical deve ser realizada, destacando-se que o procedimento mais indicado e a biopsia excisional com exame histopatologico transoperatorio programado, bem como condicoes para uma possivel cirurgia mais abrangente

Melanomas extracutaneos de cabeza y cuello / Mucosae melanoma in head and neck

Se analizan 27 melanomas de mucosa de cabeza y cuello tratados entre agosto de 1972 y febrero de 1992. La mayor parte de las lesiones correspomdieron a la conjuntiva ocular (11) y fosas nasales (9). El tratamiento de las lesiones operables consistió en la exéresis amplia del tumor primario con disección ganglionar en los cuellos clínicamente positivos (26// del total). Se asoció radioterapia postoperatoria en los casos tratados en los últimos 10 años de esta serie, sobre el tumor primario y áreas ganglionares comprometidas. Con un seguimiento del 85//, no se observaron diferencias estadísticamente significativas en la evolución según su localización, estado ganglionar o con el agregado de radioterapia. Todas las recurrencias locales fallecieron por su enfermedad. La supervivencia de la totalidad de la población incluyendo las lesiones de conjuntiva fue del 35//, y excluyendo éstas, del 24//, comparable al promedio de la literatura consultada (25// en 327 pacientes)

Tumores malignos de nariz, senos paranasale y rinofaringe, experiencia en 5 años / Malignal tumors of nose, paranasal and rhinopharyngeal sinuses, experience in 5 years

Se revisaron 53023 informes anatomopatológicos de enero de 1986 a diciembre de 1990 del Servicio de Patología del H.R. 20 de Noviembre y tratados por los servicios de Otorrinolaringología y Oncología del mismo hospital, con objeto de determinar la casuística de tumores de nariz, senos paranasales y rinofaringe durante los años mencionados y clasificándolos de acuerdo con su estirpe histológica. Se señalan los resultados obtenidos analizando frecuencia de acuerdo a sexo y edad. Se comparan los datos obtenidos con otras series de la literatura internacional. Los autores agregan una revisión clínico-patológica de los tumores malignos encontrados en la serie.