Parapharyngeal Space Tumor: Submandibular Approach Without Mandibulotomy.

INTRODUCTION: Among all head and neck tumors, only 0.5% occur in the parapharyngeal space and 80% are benign tumors. Surgery is the cornerstone of treatment. The deep location of this space and surrounding structures has given rise to a large number of surgical approaches for resection of parapharyngeal neoplasms. Our experience using the submandibular transcervical approach on 14 patients who had surgery upfront for treatment of these lesions is described. MATERIAL AND METHODS: This is a retrospective, descriptive case-series analysis of patients with parapharyngeal space tumors treated from January 2009 to July 2016, in whom carotid body tumors were excluded. Fourteen patients were included, 11 females (76.9%) and 3 males (23.1%), with a mean age of 46.9 years (SD 14.85). RESULTS: The most common symptom reported at patient's presentation to our clinic was a foreign body sensation in the oropharynx and pain. Navigation-guided surgery was used in two cases. Mean tumor size was 4.7 cm (SD 1.785). Complete resection of lesions was performed in all cases, and the major complication was massive bleeding in one case (7.1%). CONCLUSION: According to the present analysis, the submandibular transcervical approach is an effective and safe technique that allows resection of large parapharyngeal tumors, even those close to the skull base. It has minimal complication rate, prevents morbidity associated mandibulotomy and allows extension to a transparotid, transmandibular and even to an infratemporal fossa approach. Navigation is indicated in tumors < 2 cm. The submandibular transcervical approach should be considered upfront for neoplasms ≤ 7 cm, preferentially ≥ 0.5 cm distant from skull base.

[Relevance of an adequate pathologic evaluation of radical rectal resection specimens]. / Relevancia de una evaluación patológica adecuada de la resección radical de recto.

BACKGROUND: The most important prognostic factors influencing survival of patients with rectal carcinoma (RC) are lymph node metastases and mesorectal excision (ME). The adequate pathologic examination (APE) of rectal specimens is a standardized pathologic work-up that differs of the conventional colonic/intestinal pathologic work-up. The aim of this study was to determine the impact of APE on staging, lymph node retrieval and survival, with the hypotheses that APE allows high lymph node retrieval and better survival. METHODS: We retrospectively analyzed patient with surgery for RC from 2004 to 2011. We described the APE of radical rectal resection and we compared the clinical and pathological characteristics and the oncologic results, including survival after and before APE. RESULTS: A total of 185 patients were evaluated, 114 constituted the pre-APE group and 71 the APE group. The mean lymph node retrieval was 13.7 in the pre-APE group and 19.6 in the APE group (P = 0.007). In the APE group we found less local recurrence (20% vs 34%, P = 0.024), more lymph-vascular invasion (20% vs 5%, P = 0.003), higher prevalence of high grade tumors (20% vs 4%, P = 0.001), more alive patients free of disease (75% vs 49%, P = 0.001), more frequent use of neoadjuvant therapy (58% vs 31%, P = 0.001), and and better 4-year survival (78% vs 53%, P = 0.044). CONCLU- SION: The APE is crucial in patients with RC for staging and planning further treatment. An APE added to neoadjuvant or adjuvant therapy was associated with better survival.

Displasia globoide del estómago: análisis clinico-patológico e inmunohistoquímico de seis casos / Clinicopathological and immunohistochemical analysis of six cases of gastric globoid dysplasia

Antecedentes: Las lesiones preinvasivas de cáncer gástrico de tipo intestinal de Lauren son bien conocidas, sin embargo, las precursoras del carcinoma de células en anillo de sello (SRCC) no se han estudiado con detalle. La supuesta lesión precursora ha sido descrita ambiguamente y denominada como «displasia foveolar», «displasia no metaplásica» o «displasia globoide» (DG). Nosotros describimos 6 casos de DG con un análisis inmunhoistoquímico extenso previamente no descrito. Material y métodos: Recabamos 6 casos de DG de un total de 659 biopsias gástricas con diagnóstico de cáncer (1%). Realizamos el análisis morfológico e inmunohistoquímico de dichos casos. Resultados: La proporción hombre-mujer fue de 1 a 2, la edad promedio fue 62.3 a˜nos (rango 53-83 a˜nos), 2 casos ocurrieron en etapa clínica I, 2 en etapa III y 2 en etapa IV. El seguimiento es de 16 meses (rango de 10-24 meses), un paciente murió por el cáncer, 3 están vivos con enfermedad y los 2 restantes están vivos libres de enfermedad. El perfil inmunohistoquímico de la DG es: MUC5AC (+), Ki-67(+), p53+, p27(+),p16(+); MUC6(-), Na+K+ ATPasa (−) y E-cadherin con intensidad baja. Conclusión: El adecuado reconocimiento de la DG permite el desarrollo de nuevos estudios con mayor número de casos, mejor evaluación clínica mayor seguimiento y mejor caracterización de las anormalidades genéticas subyacentes. El estudio de más casos es necesario(AU)

Background: The pre-invasive lesions of Lauren’s intestinal type of gastric cancer are well recognized but those of signet ring cell carcinoma (SRCC) have not been studied in detail. The putative precursor lesion of SRCC is poorly and ambiguously described as ‘tubule neck dysplasia’, ‘‘non-metaplastic dysplasia’’ or ‘‘globoid dysplasia’’ (GD). We describe 6 six cases of GD with an extensive immunohistochemical profile that has not been previously reported. Material and method: Six cases of GD were retrieved from 659 cases of gastric biopsies positive for carcinoma (1%). Their clinical, morphological, and immunohistochemical features were analyzed. Results: The male to female ratio was 1:2, the median age was 62.3 years (range 53---83 years), two cases were in clinical stage I, 2 cases in stage III and two cases in stage IV. After a follow-up of an average of 16 months (range 10---24 months), one patient had died from the neoplastic disease, 3 are alive but with disease and the remaining 2 are alive and disease-free. The immunohistochemical profile of GD is MUC5AC (+), Ki-67(+), p53+, p27(+),p16(+); MUC6(−), Na+K+ ATPasa (−) and E-cadherin with reduced intensity. Conclusion: Correct recognition of GD enables new and larger case studies, better clinical evaluation, longer follow-up and better characterization of genetic abnormalities. Thus, the study of more cases of GD is clearly beneficial(AU)

Mixed gastric carcinoma with intestinal and cribriform patterns: a distinctive pathologic appearance associated with poor prognosis in advanced stages and a potential mimicker of metastatic breast carcinoma.

Gastric adenocarcinoma is characterized by marked heterogeneity at cytological and architectural level and frequently shows overlap between microscopic patterns. This article describes a peculiar pattern of gastric adenocarcinoma, previously unreported, that combines intestinal type adenocarcinoma with areas of cribriform pattern that resembles both architectural and cytological in situ ductal carcinoma of the breast and to the best of the authors' knowledge, there are no earlier reports of this pattern in the stomach, which has been named "gastric carcinoma with cribriform component (CGA). The authors analyzed 12 cases of intestinal type adenocarcinoma with areas at least 20% of cribriform pattern (range from 20% to 90%) that was present in 9% of intestinal type gastric adenocarcinomas in their institution. There is slight predilection for male sex, and the median age of presentation is 55.8 years. The phenotype by immunohistochemistry is the same as with conventional (non-CGA) carcinomas. CGA shows more frequent lymphovascular invasion (P = .039), perineural invasion (P = .027) and resembles both in situ and invasive cribriform carcinoma of the breast. In clinical stage III the overall 3-year survival of CGA was worse than those with non-CGA component (38.6% vs 25%; 3-year survival, P = .010) and proves to be an independent adverse factor for overall survival in a multivariate analysis. Compared with conventional gastric carcinomas, CGA is deep infiltrating, has more nodal metastases, more lymphovascular and perineural invasion, and has decreased overall survival. Thus, proper recognition and report is important, even in small biopsies or small foci.

Relevancia de una evaluación patológica adecuada de la resección radical de recto / [Relevance of an adequate pathologic evaluation of radical rectal resection specimens].

BACKGROUND: The most important prognostic factors influencing survival of patients with rectal carcinoma (RC) are lymph node metastases and mesorectal excision (ME). The adequate pathologic examination (APE) of rectal specimens is a standardized pathologic work-up that differs of the conventional colonic/intestinal pathologic work-up. The aim of this study was to determine the impact of APE on staging, lymph node retrieval and survival, with the hypotheses that APE allows high lymph node retrieval and better survival. METHODS: We retrospectively analyzed patient with surgery for RC from 2004 to 2011. We described the APE of radical rectal resection and we compared the clinical and pathological characteristics and the oncologic results, including survival after and before APE. RESULTS: A total of 185 patients were evaluated, 114 constituted the pre-APE group and 71 the APE group. The mean lymph node retrieval was 13.7 in the pre-APE group and 19.6 in the APE group (P = 0.007). In the APE group we found less local recurrence (20

, P = 0.003), higher prevalence of high grade tumors (20

, P = 0.001), more alive patients free of disease (75

, P = 0.001), more frequent use of neoadjuvant therapy (58

, P = 0.001), and and better 4-year survival (78

, P = 0.044). CONCLU- SION: The APE is crucial in patients with RC for staging and planning further treatment. An APE added to neoadjuvant or adjuvant therapy was associated with better survival.

Relevancia de una evaluación patológica adecuada de la resección radical de recto. / [Relevance of an adequate pathologic evaluation of radical rectal resection specimens].

BACKGROUND: The most important prognostic factors influencing survival of patients with rectal carcinoma (RC) are lymph node metastases and mesorectal excision (ME). The adequate pathologic examination (APE) of rectal specimens is a standardized pathologic work-up that differs of the conventional colonic/intestinal pathologic work-up. The aim of this study was to determine the impact of APE on staging, lymph node retrieval and survival, with the hypotheses that APE allows high lymph node retrieval and better survival. METHODS: We retrospectively analyzed patient with surgery for RC from 2004 to 2011. We described the APE of radical rectal resection and we compared the clinical and pathological characteristics and the oncologic results, including survival after and before APE. RESULTS: A total of 185 patients were evaluated, 114 constituted the pre-APE group and 71 the APE group. The mean lymph node retrieval was 13.7 in the pre-APE group and 19.6 in the APE group (P = 0.007). In the APE group we found less local recurrence (20

vs 34

, P = 0.024), more lymph-vascular invasion (20

vs 5

, P = 0.003), higher prevalence of high grade tumors (20

vs 4

, P = 0.001), more alive patients free of disease (75

vs 49

, P = 0.001), more frequent use of neoadjuvant therapy (58

vs 31

, P = 0.001), and and better 4-year survival (78

vs 53

, P = 0.044). CONCLU- SION: The APE is crucial in patients with RC for staging and planning further treatment. An APE added to neoadjuvant or adjuvant therapy was associated with better survival.