Time trends in the prevalence of HPV in oropharyngeal squamous cell carcinomas in northern Spain (1990-2009).

Recent studies support an important role for human papillomavirus (HPV) in oropharyngeal squamous cell carcinomas (OPSCC), although the incidence varies widely depending on the geographic location and time period studied. The aim of this study was to determine the proportion of HPV in a large cohort of OPSCC in northern Spain in the years 1990-2009. Clinical records and paraffin embedded tumor specimens of 248 consecutive patients surgically treated for OPSCC (140 tonsillar and 108 base of tongue) between 1990 and 2009 were retrieved. OPSCC cases were histomorphologically evaluated, and protein expression of p16 and p53 was analyzed by immunohistochemistry. Detection of high-risk HPV DNA was performed by GP5+/6+-PCR and in situ hybridization (ISH). Thirty cases (12%) were positive for p16 immunostaining, of which eight (3.2% of the total series) were found positive for HPV type 16 by genotyping of GP5+6+-PCR products. All HPV GP5+/6+-PCR-positive tumors were p53-immunonegative, seven had a basaloid morphology and seven were also positive by HPV ISH. Presence of HPV correlated inversely with tobacco and alcohol consumption (p < 0.001), but not with age of onset of OPSCC. Overall survival was better in the HPV-positive group, although not statistically significant (p = 0.175). OPSCC patients in northern Spain demonstrated a low involvement of HPV, increasing (although not significantly, p = 0.120) from 1.8% in 1990-1999 to 6.1% of cases in 2000-2009.

Oncological results after surgical treatment of squamous cell cancer of the lateral wall of the oropharynx.

OBJECTIVES: The gold standard of treatment of cancer of the lateral wall of the oropharynx continues to be unclear, especially in advanced stages. In this study, we report our experience with surgical treatment of these cancers and describe the functional and oncological results of the procedures. STUDY DESIGN: Retrospective review. METHODS: A total of 155 previously untreated patients with squamous cell carcinoma of the lateral wall of the oropharynx who underwent a surgical resection of the lesion at our department from January 1990 to January 2008 were included. Sixty-seven percent of these patients received postoperative radiotherapy. The records of these patients were reviewed to obtain measures such as local and regional control, disease-specific survival, and speech and swallowing function. RESULTS: Six patients had a stage I disease, 15 had a stage II disease, 31 had a stage III disease, 86 had a stage IVA, and 17 had stage IVB disease. The overall recurrence rate was 60%, and the local recurrence rate was 40%. The 5-year overall survival and disease-specific survival rates were 33% and 43%, respectively. Five-year disease-specific survival rates by stage were as follows: 100%, 59%, 57%, 31%, and 33% for stages I to IVB, respectively. Multivariate analysis showed two parameters that were independent predictors of a reduced disease-specific survival: cervical lymph node metastases pN2-3 (P = .027) and primary tumor classified as pT3-4 (P = .029). In 122 patients, a tracheotomy was performed, and it couldn't be sealed in 23% of them. Oral alimentation was successfully recovered in 93% of the patients. CONCLUSIONS: Surgical treatment of cancer of the lateral wall of the oropharynx provides acceptable oncological and functional results, especially in early and moderately advanced stages (stages I-III). In advanced stages (stage IV), we obtained good functional preservation rates but poor oncological outcomes. Consequently, these groups of patients could be considered for another treatment modality, such as radiochemotherapy.

Fallo barorreceptor tras la resección bilateral de paragangliomas carotídeos / Baroreceptor failure after bilateral resection of carotid artery parangliomas

Los paragangliomas (PGL) múltiples en la región de la cabeza y cuello son patologías raras. Presentamos el caso de una paciente de 24 años que fue intervenida en nuestro centro de PGL carotídeos bilaterales y que desarrolló un fallo barorreceptor después de la resección de éstos. Aunque resulta una complicación poco frecuente, es importante conocerla para diagnosticarla y tratarla rápidamente, evitando así mayores complicaciones postoperatorias (AU)

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications (AU)

Baroreceptor failure after bilateral resection of carotid artery parangliomas.

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications.

Papilomas invertidos rinosinusales. Revisión de 61 casos / Inverted sinonasal papillomas. Review of 61 cases

Introducción: Los papilomas invertidos son neoplasias raras localizadas preferentemente en la pared lateral nasal, caracterizadas por la tendencia a recidivar y su potencial transformación en neoplasias malignas. El objetivo de este trabajo es analizar nuestra experiencia en el tratamiento de estas lesiones, especialmente el abordaje endoscópico. Material y métodos: Se realizó un estudio retrospectivo de 61 pacientes tratados en nuestro hospital desde 1983. Se recogieron los datos clinicopatológicos de los pacientes, el tratamiento aplicado y la evolución en el tiempo tras éste. El tiempo medio de seguimiento fue de 51 meses (rango: 6–228 meses). Resultados: Treinta y ocho de los pacientes (62%) eran hombres y 23 mujeres (38%), con una edad media de 58 años (rango: 22–80). El síntoma principal fue insuficiencia respiratoria nasal unilateral en el 91%, seguido de rinorrea en el 46%. La localización más frecuente fue el etmoides (51%), seguida del seno maxilar (28%) y la pared lateral nasal (21%). El 78% de los casos tenía sinusitis asociada y el 43%, poliposis. La clasificación por estadios de Krouse fue del 35% en estadio I, 37% en estadio II, 18% en estadio III y 8% en el IV. El 37% de los pacientes presentaba remodelación ósea en la TAC. Seis de los 42 pacientes operados por cirugía endoscópica nasal (CEN) presentaron recidiva (14%), mientras que de los pacientes a los que se operó por técnicas abiertas, presentaron recidiva 6 de 9 (67%). El tiempo medio a la recidiva fue de 41 meses. Diez de los pacientes presentaron papilomas invertidos malignizados, nueve de ellos fueron diagnosticados desde el principio como neoplasias malignizadas y uno se malignizó durante el seguimiento. Discusión y conclusiones: La CEN es el método de elección para el tratamiento de la mayor parte de los papilomas invertidos con resultados equiparables o, incluso, mejores que con las técnicas abiertas. El estrecho seguimiento de los pacientes por largos períodos de tiempo es necesario para detectar de forma precoz las recidivas y poder practicar cirugías de rescate (AU)

Introduction: Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach. Material and method: We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6–228 months). Results: Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22–80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up. Discussion and conclusions: The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage (AU)

[Inverted sinonasal papillomas. Review of 61 cases]. / Papilomas invertidos rinosinusales. Revisión de 61 casos.

INTRODUCTION: Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach. MATERIAL AND METHOD: We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6-228 months). RESULTS: Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22-80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up. DISCUSSION AND CONCLUSIONS: The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage.

[Sinonasal mucosal melanomas. Review of 17 case]. / Melanomas mucosos rinosinusales. Revisión de 17 casos.

INTRODUCTION: Mucosal melanomas (MM) represent 1.3 % of all melanomas; 55 % of them are located in the head and neck region mainly in the sinonasal and oropharyngeal cavity. Sinonasal mucosal melanomas have a high rate of local recurrence and a high risk of developing metastases, two reasons explaining the low survival rate. MATERIAL AND METHOD: We present 17 cases of sinonasal mucosal melanomas that were diagnosed and treated in our department from 1984 to July, 2008. The patients were studied by age, gender, site of presentation of the tumour, symptoms, radiology findings, treatment and course. RESULTS: Seventeen patients with sinonasal mucosal melanomas were studied. Of these 64.7 % were females and the mean age at presentation was 74 (range 48 to 93 years). Twelve cases developed in the nasal cavity and 5 in the paranasal sinuses. The most frequent site of presentation was the septum (35 %), and the most common symptom was epistaxis (77 %). Three patients rejected any treatment, 12 of the patients were treated surgically, one received chemotherapy and another chemotherapy plus radiotherapy. The 5 year disease-specific survival rate was 35.7 %. DISCUSSION AND CONCLUSIONS: Sinonasal mucosal melanomas are rare tumours with a high mortality. The treatment of choice is still surgical resection with wide surgical margins. Even so, the main cause of treatment failure is local recurrence, followed by the development of metastases. Because of the poor prognosis with this tumour, new treatment strategies are necessary.

Melanomas mucosos rinosinusales. Revisión de 17 casos / Sinonasal mucosal melanomas. Review of 17 cases

Introducción: Los melanomas mucosos (MM) representan el 1,3 % del total de melanomas. El 55 % de ellos se encuentra en la región de la cabeza y el cuello, principalmente en el área rinosinusal y la orofaringe. Los MM rinosinusales tienen una alta tasa de recurrencias locales y una gran capacidad para desarrollar metástasis, lo que se traduce en una supervivencia muy corta. Material y método: Se presentan los MM rinosinusales diagnosticados y tratados en nuestro servicio desde 1984 a julio de 2008. Se recogieron datos clínico patológicos que incluyen edad, sexo, sitio y síntomas de presentación, hallazgos radiológicos, tratamiento y evolución. Resultados: Se realiza una revisión de 17 pacientes. El 65% eran mujeres. La media (intervalo) de la edad a la presentación fue 74 (48-93) años. Los melanomas se originaron en la cavidad nasal en 12 pacientes y en los senos paranasales en 5. El lugar de presentación más frecuente fue el septum (67 %), y el síntoma de presentación fue la epistaxis (77 %).Tres pacientes rehusaron recibir tratamiento, 12 fueron tratados quirúrgicamente, 1 con quimioterapia y 1 con quimioterapia y radioterapia. La supervivencia específica a 5 años fue del 35,7 %. Discusión y conclusiones: Los melanomas rinosinusales son tumores raros pero con una elevada mortalidad. El tratamiento de elección sigue siendo la resección quirúrgica con amplios márgenes quirúrgicos. A pesar de ello, la principal causa de fracaso del tratamiento son las recidivas locales y el desarrollo de metástasis. Dado el mal pronóstico de este tumor, parecen necesarias nuevas estrategias terapéuticas (AU)

Introduction: Mucosal melanomas (MM) represent 1.3 % of all melanomas; 55 % of them are located in the head and neck region mainly in the sinonasal and oropharyngeal cavity. Sinonasal mucosal melanomas have a high rate of local recurrence and a high risk of developing metastases, two reasons explaining the low survival rate. Material and method: We present 17 cases of sinonasal mucosal melanomas that were diagnosed and treated in our department from 1984 to July, 2008. The patients were studied by age, gender, site of presentation of the tumour, symptoms, radiology findings, treatment and course. Results: Seventeen patients with sinonasal mucosal melanomas were studied. Of these 64.7% were females and the mean age at presentation was 74 (range 48 to 93 years).Twelve cases developed in the nasal cavity and 5 in the paranasal sinuses. The most frequent site of presentation was the septum (35 %), and the most common symptom was epistaxis (77 %). Three patients rejected any treatment, 12 of the patients were treated surgically, one received chemotherapy and another chemotherapy plus radiotherapy. The 5 year disease-specific survival rate was 35.7%. Discussion and conclusions: Sinonasal mucosal melanomas are rare tumours with a high mortality. The treatment of choice is still surgical resection with wide surgical margins. Even so, the main cause of treatment failure is local recurrence, followed by the development of metastases. Because of the poor prognosis with this tumour, new treatment strategies are necessary (AU)