Carcinoma linfoepitelial de cuello uterino con recurrencia a distancia / Lymphoepithelioma-like carcinoma of the cervix with distant recurrence

Resumen El carcinoma similar al linfoepitelioma (LELC) del cuello uterino es una variante infrecuente del carcinoma de células escamosas. Se presenta el caso de una mujer con un tumor exofítico en el cuello uterino de consistencia aumentada, sangrado al tacto y parametrios libres de tumor clasificándose como etapa clínica IBI; el estudio histopatológico reportó LELC con recurrencia a distancia al año de seguimiento. Debido a su buen pronóstico existen pocos casos reportados de recurrencia posterior al tratamiento inicial.

Abstract Lymphoepithelioma-like carcinoma (LELC) of the cervix is an uncommon variant of squamous cell carcinoma. We present the case of a woman with an exophytic tumor on the cervix of increased consistency, bleeding to the touch and tumor-free parametriums classified as clinical stage IBI; the histopathological study reported LELC with distant recurrence at one year of follow-up. Due to its good prognosis, there are few reported cases of recurrence after initial treatment.

[Value of (99m)Tc tetrofosmin scan in well-differentiated thyroid cancer].

BACKGROUND: Patients with cold thyroid nodules without ultrasound malignant suspicion and with benign/undetermined cytology may be subjected to follow-up surveillance. 99mTc-tetrofosmin scan (99mTc-TS) may identify patients where this observation can be performed with more certainty. Absence of uptake never occurs in carcinoma patients. Our objective was to determine the 99mTc-TS negative predictive value (NPV) in patients with cold thyroid nodules. METHODS: An evaluation with 99mTc-TS was conducted prior to surgery in patients with thyroid gland tumor who were candidates for surgery. All patients underwent thyroidectomy according to histology; NPV and test sensitivity were evaluated when compared with the histopathological result. Then, 296-370 MBq (8-10 mCi) of 99mTc-tetrofosmin was administered, and scan images were evaluated after 120 min. Scan result was reported as a) with increased metabolic activity (IMA) or b) without increased metabolic activity (WIMA). RESULTS: Included in the study were 86 consecutive patients. In 60 patients the scan showed IMA, 20/60 (33%) with carcinoma, 67% with benign nodule. In 26 (30.2%) the scan was WIMA. In this group, 3/26 (11.5%) had carcinoma and (88.4%) had a benign neoplasia. Sensitivity = 91.43 (95% CI = 80.73-100), specificity = 45.10 (95% CI = 30.46-59.73), positive predictive value = 53.33 (95% CI = 39.8-66.79) and NPV = 88.46 (95% CI 74.26-100). Negative probability ratio = 0.19. CONCLUSIONS: IMA-99mTc-TS is less specific in thyroid cancer; nevertheless, in WIMA patients the possibility of carcinoma is 13%. Most patients (70%) showed IMA, 33% with carcinoma. WIMA-NPV = 30%. 99mTc-TS may be useful in the therapeutic decision of patients with thyroid nodule with concerns about surgery. Its usefulness lies in the NPV.

[Unsual clinical signs of primary hyperparathroidism]. / Manifestaciones clínicas inusuales del hiperparatiroidismo primario.

BACKGROUND: A growing number of patients with primary hyperparathyroidism (PHPT) are diagnosed in the absence of symptoms following routine biochemical screening. However, in some countries, overt manifestations and osteitis fibrosa cystica (OFC) still dominate the clinical profile of PHPT patients. METHODS: We retrospectively studied clinical and biochemical manifestations of 47 consecutive patients with primary hyperparathyroidism who were treated with parathyroidectomy from October 1993 to June 2005. RESULTS: Mean age was of 51.3 years. Our sample included 40 women (85%) and 7 men (15%). Seventy eight percent of cases had radiological features of OFC, namely subperiosteal bone resorption, cortical cysts and osteopenia. Pathological fracture occurred in nine patients (19.1%). Fifteen (32%) patients had clinically evident bony deformities or brown tumors mostly located in the mandible and maxilla. CONCLUSIONS: Our results indicate that symptomatic osteitis fibrosa cystica and severe decrease of bone mineral density were the primary manifestations of primary hyperparathyroidism. Most patients were referred to an oncology hospital for treatment due to a suspected malignant neoplasm. A comprehensive clinical evaluation with biochemical markers, imaging studies and histological results is needed to establish a possible diagnosis of primary hyperparathyroidism.

Valor de la gammagrafía con Tc-99m-tetrofosmín en el diagnóstico del cáncer bien diferenciado de tiroides / Value of (99m)Tc tetrofosmin scan in well-differentiated thyroid cancer

Introducción: Los pacientes con nódulos tiroideos hipocaptantes sin sospecha ultrasonográfica y con citología benigna o indeterminada pueden ser vigilados. El gammagrama con Tc- 99m-tetrofosmín (Tc-99m-TS) identifica pacientes en los que la vigilancia es más segura. La ausencia de captación nunca ocurre en pacientes con carcinoma. El objetivo de este estudio fue conocer el valor predictivo negativo del Tc-99m-TS en pacientes con nódulo tiroideo. Material y métodos: Evaluación preoperatoria con Tc-99m-TS de pacientes con nódulo tiroideo candidatos a cirugía. Tiroidectomía de acuerdo con el diagnóstico en todos. Evaluación de valor predictivo negativo y sensibilidad al comparar con el resultado histopatológico. Se administraron 296-370 MBq (8-10 mCi) de Tc-99m-TS; evaluación de imágenes a los 120 minutos. Resultado reportado con actividad metabólica aumentada (AMA) o sin actividad metabólica aumentada (SAMA). Resultados: Se incluyeron 86 pacientes consecutivos. Sesenta (69.7 %) tuvieron AMA, 20/60 con carcinoma (33 %), en 67 % el diagnóstico fue de nódulo benigno. En 26 (30.2 %) SAMA, 11.5 % tuvo carcinoma y 88.4 % neoplasia benigna. Sensibilidad de 91.43 % (IC 95 % = 80.73-100 %), especificidad de 45.10 % (IC 95 % = 30.46-59.73), valor predictivo positivo de 53.33 % (IC 95 % = 39.8-66.79), valor predictivo negativo de 88.46 % (IC 95 % = 74.26-100). Razón de verosimilitud negativa = 0.19. Conclusiones: Tc-99m-TS con AMA es poco específico en cáncer tiroideo; en pacientes SAMA 13 % tiene carcinoma. La mayoría de los pacientes (70 %) mostró AMA, 33 % con carcinoma. Valor predictivo negativo en grupo SAMA = 88 %. Tc-99m-TS podría ser útil en la decisión terapéutica de pacientes con nódulo tiroideo en los que existe duda de cirugía; su utilidad radica en el valor predictivo negativo.

BACKGROUND: Patients with cold thyroid nodules without ultrasound malignant suspicion and with benign/undetermined cytology may be subjected to follow-up surveillance. 99mTc-tetrofosmin scan (99mTc-TS) may identify patients where this observation can be performed with more certainty. Absence of uptake never occurs in carcinoma patients. Our objective was to determine the 99mTc-TS negative predictive value (NPV) in patients with cold thyroid nodules. METHODS: An evaluation with 99mTc-TS was conducted prior to surgery in patients with thyroid gland tumor who were candidates for surgery. All patients underwent thyroidectomy according to histology; NPV and test sensitivity were evaluated when compared with the histopathological result. Then, 296-370 MBq (8-10 mCi) of 99mTc-tetrofosmin was administered, and scan images were evaluated after 120 min. Scan result was reported as a) with increased metabolic activity (IMA) or b) without increased metabolic activity (WIMA). RESULTS: Included in the study were 86 consecutive patients. In 60 patients the scan showed IMA, 20/60 (33%) with carcinoma, 67% with benign nodule. In 26 (30.2%) the scan was WIMA. In this group, 3/26 (11.5%) had carcinoma and (88.4%) had a benign neoplasia. Sensitivity = 91.43 (95% CI = 80.73-100), specificity = 45.10 (95% CI = 30.46-59.73), positive predictive value = 53.33 (95% CI = 39.8-66.79) and NPV = 88.46 (95% CI 74.26-100). Negative probability ratio = 0.19. CONCLUSIONS: IMA-99mTc-TS is less specific in thyroid cancer; nevertheless, in WIMA patients the possibility of carcinoma is 13%. Most patients (70%) showed IMA, 33% with carcinoma. WIMA-NPV = 30%. 99mTc-TS may be useful in the therapeutic decision of patients with thyroid nodule with concerns about surgery. Its usefulness lies in the NPV.

Manifestaciones clínicas inusuales del hiperparatiroidismo primario / Unsual clinical signs of primary hyperparathroidism

Introducción: Un creciente número de pacientes con hiperparatiroidismo primario son diagnosticados en la ausencia de síntomas, gracias a la determinación rutinaria de calcio sérico. Sin embargo, en algunos países las manifestaciones típicas continúan dominando la presentación del hiperparatiroidismo primario. Métodos: Estudiamos retrospectivamente las manifestaciones clínicas y bioquímicas de 47 pacientes consecutivos con hiperparatiroidismo primario, tratados con paratiroidectomía entre octubre de 1993 y junio de 2005. Resultados: La edad media fue de 51.3 años. Se incluyeron 40 mujeres (85%) y siete varones (15%). El 63% de los pacientes fue referido por la sospecha de neoplasia maligna. En 78% de los casos se identificaron lesiones radiológicas compatibles con osteítis fibrosa quística, resorción subperóstica, lesiones líticas múltiples, osteopenia y osteoporosis. La presencia de fractura en terreno patológico se observó en 19.1%. Quince pacientes (32%) tenían tumores pardos, con localización más frecuentemente en la mandíbula y la maxila. Conclusiones: En esta serie, la osteítis fibrosa quística sintomática y la severa disminución de la densidad mineral ósea fueron las manifestaciones dominantes del hiperparatiroidismo primario. En su mayoría, los pacientes fueron referidos a una unidad oncológica para su tratamiento debido a la sospecha de alguna neoplasia maligna. Una adecuada evaluación clínica, bioquímica, radiológica e histológica es necesaria para establecer el posible diagnóstico de hiperparatiroidismo.

BACKGROUND: A growing number of patients with primary hyperparathyroidism (PHPT) are diagnosed in the absence of symptoms following routine biochemical screening. However, in some countries, overt manifestations and osteitis fibrosa cystica (OFC) still dominate the clinical profile of PHPT patients. METHODS: We retrospectively studied clinical and biochemical manifestations of 47 consecutive patients with primary hyperparathyroidism who were treated with parathyroidectomy from October 1993 to June 2005. RESULTS: Mean age was of 51.3 years. Our sample included 40 women (85%) and 7 men (15%). Seventy eight percent of cases had radiological features of OFC, namely subperiosteal bone resorption, cortical cysts and osteopenia. Pathological fracture occurred in nine patients (19.1%). Fifteen (32%) patients had clinically evident bony deformities or brown tumors mostly located in the mandible and maxilla. CONCLUSIONS: Our results indicate that symptomatic osteitis fibrosa cystica and severe decrease of bone mineral density were the primary manifestations of primary hyperparathyroidism. Most patients were referred to an oncology hospital for treatment due to a suspected malignant neoplasm. A comprehensive clinical evaluation with biochemical markers, imaging studies and histological results is needed to establish a possible diagnosis of primary hyperparathyroidism.

Evolution of maxillofacial brown tumors after parathyroidectomy in primary hyperparathyroidism.

BACKGROUND: Brown tumor occasionally affects the facial bones. Clinically, these lesions can be mistaken for a neoplasm. Opinions are divided on the course of management of the bony lesions once parathyroidectomy has been carried out. METHODS: We treated 22 patients with primary hyperparathyroidism and osteitis fibrosa cystica and observed their clinical and biochemical recovery. RESULTS: Fifteen patients (68.2%) had brown tumors in mandible, and 7 (31.8%) in maxilla. After parathyroidectomy, 21 patients had normal total serum calcium values. All brown tumors presented a spontaneous progressive regression; in 18 cases, regression was total, with a mean time period of 10 months. Two patients had partial regression after nearly 2 years. Another 2 patients were lost to follow-up. CONCLUSIONS: After successful parathyroid surgery, the bony lesions tended to regress spontaneously, either partially or completely. However, if the lesion is disfiguring or symptomatic, surgical excision may be indicated.

[Multiple maxillofacial brown tumors as primary hyperparathyroidism manifestation]. / Múltiples tumores pardos maxilofaciales como manifestación de hiperparatiroidismo primario.

OBJECTIVE: In order to analyze the differential diagnosis of giant-cell lesion in facial bones, we present a case of a patient without a previously diagnosed primary hyperparathyroidism that displayed multiple maxillofacial brown tumors as the initial clinical manifestation of the disease. CASE DESCRIPTION: A 70 year-old female with amandible tumor and one year of disease progression. Tumor biopsy confirmed the presence of a giant-cell lesion. Radiologically, we confirmed the presence of another two lytic lesions in the maxillofacial region. During biochemical evaluation prior to surgery, the possibility of hyperparathyroidism was considered. Using computed tomography, we noted a parathyroid tumor in an atypical location. Surgical resection confirmed the presence of an adenoma. Postoperatively, the patient developed symptomatic hypocalcemia and was managed with calcium supplementation in addition to calcitriol. At 4 months after surgery mandibular swelling had regressed partially and serum calcium levels returned to normal levels. CONCLUSION: The detection of giant-cell bone lesions in the maxillofacial region is a strategic diagnostic finding as several entities, among these brown tumor hyperparathyroidism can display similar histologic imaging findings. Only systematic clinical, radiologic, and biochemical evaluation can allow for a definitive diagnosis. The presence of multiple simultaneous maxillofacial brown tumors in primary hyperparathyroidism is an infrequent ocurrence, and only on rare occasions can this be the first sign of the disease.

[Partial pharyngolaryngectomies for treatment of pharyngolaryngeal cancer]. / Faringo-laringectomías parciales para el tratamiento del cáncer faringolaríngeo.

BACKGROUND: We undertook this study to evaluate the results obtained with conservation therapy of the larynx in patients with laryngopharyngeal epidermoid carcinoma. METHODS: Patients with stages I and II epidermoid cancer of the larynx and pharynx were included. All patients were evaluated endoscopically, functionally, and with cervical tomography. Results of the procedures were evaluated on the basis of oncological control and laryngeal function (voice, swallowing and ventilation). RESULTS: There were 41 male patients with a median age of 55 years. In 32 patients, surgery was the initial treatment and in nine patients as rescue treatment after radiotherapy. In 58.5% the location was glottic, in 22% supraglottic, in 12% glotto-supraglottic and in 7% vallecular and hypopharynx. Subtotal laryngectomy was performed with cricohyoidepiglottopexy in 18 patients, frontolateral in 11, supraglottic in 5, subglottic-epiglottectomy in 3, hemipharyngolaryngectomy in 3, and in one hemiglottectomy. The time until decannulation and removal of nasogastric catheter depended on the type of surgery. One patient (2%) had to be subjected to a rescue laryngectomy due to constant aspiration. This patient demonstrated residual tumor in the sample. Nine patients had some type of complication, the most frequent being wound infection (7.3%). One patient died postoperatively due to sepsis (2.4%), and another patient died due to systemic causes 4 months after the intervention. Median follow-up time is 25 months and no patient has presented tumor recurrence. CONCLUSIONS: Voice conservation surgery is an alternative to mutilation of the larynx in patients with locally advanced neoplasms of the larynx with a high risk of recurrence if treated with radiotherapy.

Faringo-laringectomías parciales para el tratamiento del cáncer faringolaríngeo / Partial pharyngolaryngectomies for treatment of pharyngolaryngeal cancer

BACKGROUND: We undertook this study to evaluate the results obtained with conservation therapy of the larynx in patients with laryngopharyngeal epidermoid carcinoma. METHODS: Patients with stages I and II epidermoid cancer of the larynx and pharynx were included. All patients were evaluated endoscopically, functionally, and with cervical tomography. Results of the procedures were evaluated on the basis of oncological control and laryngeal function (voice, swallowing and ventilation). RESULTS: There were 41 male patients with a median age of 55 years. In 32 patients, surgery was the initial treatment and in nine patients as rescue treatment after radiotherapy. In 58.5% the location was glottic, in 22% supraglottic, in 12% glotto-supraglottic and in 7% vallecular and hypopharynx. Subtotal laryngectomy was performed with cricohyoidepiglottopexy in 18 patients, frontolateral in 11, supraglottic in 5, subglottic-epiglottectomy in 3, hemipharyngolaryngectomy in 3, and in one hemiglottectomy. The time until decannulation and removal of nasogastric catheter depended on the type of surgery. One patient (2%) had to be subjected to a rescue laryngectomy due to constant aspiration. This patient demonstrated residual tumor in the sample. Nine patients had some type of complication, the most frequent being wound infection (7.3%). One patient died postoperatively due to sepsis (2.4%), and another patient died due to systemic causes 4 months after the intervention. Median follow-up time is 25 months and no patient has presented tumor recurrence. CONCLUSIONS: Voice conservation surgery is an alternative to mutilation of the larynx in patients with locally advanced neoplasms of the larynx with a high risk of recurrence if treated with radiotherapy.

[Prognostic factors in head and neck mucoepidermoid carcinoma]. / Factores pronósticos en carcinoma mucoepidermoide de cabeza y cuello.

BACKGROUND: In patients with mucoepidermoid carcinoma (MEC) originating in salivary glands, because of the relative rarity of these tumors and the remarkable variability in their biological behavior, opinions differ about appropriate classification, grading, and treatment. OBJECTIVE: We undertook this study to analyze clinical and histological prognostic factors in a series of patients with MEC using univariate and multivariate survival analyses. METHODS: We reviewed 47 patients with MEC treated at our institution from 1985 to 2000. Clinical, epidemiological, treatment and follow-up data were obtained from medical records. All cases were histologically reviewed. The influence of prognostic factors on 5- and 10-year disease-specific survival was analyzed using Kaplan-Meier actuarial method and log-rank test. Cox regression tests were used to analyze the impact of the prognostic factors on survival. RESULTS: Females represented 59.6% of the patients. The major salivary glands were affected in 74.5%. Overall survival at 5 and 10 years was 78.3% and 69.3%, respectively. Disease-free survival at 5 years was 73.9% and at 10 years was 67.5%. Multivariate survival analysis revealed that tumor size (T4) (p = 0.0008), regional metastasis (p = 0.000), high histological grade (p = 0.0002), perineural invasion (p = 0.000), positive margin (p = 0.000), necrosis (p = 0.005), and intracystic component <20% (p = 0.0002) were all correlated with a poor prognosis. CONCLUSIONS: Clinical stage and histological grade are the main prognostic factors in mucoepidermoid carcinoma. Nevertheless, our univariate and multivariate analyses showed that other clinical and histological prognostic factors are independent significant indicators.

Factores pronósticos en carcinoma mucoepidermoide de cabeza y cuello / Prognostic factors in head and neck mucoepidermoid carcinoma

BACKGROUND: In patients with mucoepidermoid carcinoma (MEC) originating in salivary glands, because of the relative rarity of these tumors and the remarkable variability in their biological behavior, opinions differ about appropriate classification, grading, and treatment. OBJECTIVE: We undertook this study to analyze clinical and histological prognostic factors in a series of patients with MEC using univariate and multivariate survival analyses. METHODS: We reviewed 47 patients with MEC treated at our institution from 1985 to 2000. Clinical, epidemiological, treatment and follow-up data were obtained from medical records. All cases were histologically reviewed. The influence of prognostic factors on 5- and 10-year disease-specific survival was analyzed using Kaplan-Meier actuarial method and log-rank test. Cox regression tests were used to analyze the impact of the prognostic factors on survival. RESULTS: Females represented 59.6% of the patients. The major salivary glands were affected in 74.5%. Overall survival at 5 and 10 years was 78.3% and 69.3%, respectively. Disease-free survival at 5 years was 73.9% and at 10 years was 67.5%. Multivariate survival analysis revealed that tumor size (T4) (p = 0.0008), regional metastasis (p = 0.000), high histological grade (p = 0.0002), perineural invasion (p = 0.000), positive margin (p = 0.000), necrosis (p = 0.005), and intracystic component <20% (p = 0.0002) were all correlated with a poor prognosis. CONCLUSIONS: Clinical stage and histological grade are the main prognostic factors in mucoepidermoid carcinoma. Nevertheless, our univariate and multivariate analyses showed that other clinical and histological prognostic factors are independent significant indicators.

Múltiples tumores pardos maxilofaciales como manifestación de hiperparatiroidismo primario / Multiple maxillofacial brown tumors as primary hyperparathyroidism manifestation

Objetivo: Con el fin de analizar el diagnóstico diferencial de las lesiones óseas con células gigantes en los huesos faciales, presentamos un caso con hiperparatiroidismo primario no diagnosticado previamente, que presentó múltiples tumores pardos maxilofaciales como primera manifestación clínica de la enfermedad. Caso clínico: Mujer de 70 años de edad con tumor en el arco anterior de la mandíbula de un año de evolución. Una biopsia confirmó la presencia de una lesión con células gigantes. Radiológicamente se corroboró la presencia de otras dos lesiones líticas en la región maxilofacial. Durante la evaluación bioquímica previa a la cirugía se consideró la posibilidad de hiperparatiroidismo. Por tomografía computarizada se localizó tumor de paratiroides en una posición atípica. La resección quirúrgica confirmó adenoma de paratiroides. La paciente cursó con hipocalcemia sintomática, siendo manejada con suplementos de calcio y calcitriol. Al cuarto mes de la cirugía, persistía con cifras normales de calcio sérico y el tumor mandibular se había reducido parcialmente. Conclusiones: La detección de una lesión ósea con células gigantes en la región maxilofacial es un elemento diagnóstico primordial puesto que varias entidades, entre ellas el tumor pardo del hiperparatiroidismo, pueden tener una imagen histológica similar. Sólo una evaluación clínica, radiológica y bioquímica sistemática puede permitir un diagnóstico definitivo. La presencia de múltiples tumores pardos maxilofaciales simultáneos en el hiperparatiroidismo primario es poco común, y en raras ocasiones puede ser el primer signo de la enfermedad.

OBJECTIVE: In order to analyze the differential diagnosis of giant-cell lesion in facial bones, we present a case of a patient without a previously diagnosed primary hyperparathyroidism that displayed multiple maxillofacial brown tumors as the initial clinical manifestation of the disease. CASE DESCRIPTION: A 70 year-old female with amandible tumor and one year of disease progression. Tumor biopsy confirmed the presence of a giant-cell lesion. Radiologically, we confirmed the presence of another two lytic lesions in the maxillofacial region. During biochemical evaluation prior to surgery, the possibility of hyperparathyroidism was considered. Using computed tomography, we noted a parathyroid tumor in an atypical location. Surgical resection confirmed the presence of an adenoma. Postoperatively, the patient developed symptomatic hypocalcemia and was managed with calcium supplementation in addition to calcitriol. At 4 months after surgery mandibular swelling had regressed partially and serum calcium levels returned to normal levels. CONCLUSION: The detection of giant-cell bone lesions in the maxillofacial region is a strategic diagnostic finding as several entities, among these brown tumor hyperparathyroidism can display similar histologic imaging findings. Only systematic clinical, radiologic, and biochemical evaluation can allow for a definitive diagnosis. The presence of multiple simultaneous maxillofacial brown tumors in primary hyperparathyroidism is an infrequent ocurrence, and only on rare occasions can this be the first sign of the disease.

[Primary melanoma of the oral mucosa. Experience of the Oncology Hospital of Centro Médico Nacional Siglo XXI]. / Melanoma primario de la mucosa oral. Experiencia del Hospital de Oncología.

BACKGROUND: Primary intraoral melanoma is extremely rare and carries a poor prognosis. Treatment of choice remains controversial. Our aim was to define the clinical features of this disease and to evaluate treatment methods. METHODS: We retrospectively studied 14 patients with primary malignant melanoma of the oral cavity seen at the Oncology Hospital of the Mexican Institute of Social Security (IMSS), 21st Century National Medical Center (CMN-SXXI) between 1991 and 2005. The main variables studied were clinical findings, response to therapy, and outcome. RESULTS: In five males (35.7%) and nine females (64.3%) with a mean age of 65 years, tumor locations included hard palate (nine cases), maxillary gingiva (three cases), hard/soft palate (one case) and lip (one case). Pre-existing melanotic pigmentation was present in two patients. Nine patients were in stage I, four in stage II, and one was in stage III. Surgical excision was the primary treatment in 11 cases; four patients underwent simultaneous neck dissections. All patients in stage II received adjuvant radiation therapy. After a 3-year follow-up, three patients of those presenting stage I are still alive (33.3%, 3/9 cases), and all patients in stages II and III eventually died of the disease. CONCLUSIONS: Early diagnosis of pigmented lesions in the mouth along with adequate tumor resection may improve the prognosis of this disease; however, in advanced disease stage it may be reasonable to infer that major improvements in outcome after treatment of malignant melanoma of the oral cavity may not be carried out until more effective systemic therapy becomes available.

[Lymphatic mapping and sentinel lymph node biopsy in patients with high risk squamous cell carcinoma of the skin]. / Mapeo linfático y biopsia del ganglio centinela en pacientes con carcinoma epidermoide cutáneo de alto riesgo.

BACKGROUND: Some sub-groups of cutaneous squamous cell carcinoma (CSCC) display a higher risk for regional metastasis. Sentinel lymph node staging has been used successfully to evaluate nodal metastasis in selective tumors. OBJECTIVE: Assess the feasibility of sentinel node to detect occult regional lymph node metastasis in high-risk CSCC. MATERIAL AND METHODS: Between January 2002 and March 2004, a total of 20 patients received pre-operative lymphoscintigraphy and sentinel lymphadenectomy for high-risk CSCC with clinically non-palpable regional lymph nodes. RESULTS: In one of each 5 patients (20%), sentinel lymph node showed histological evidence of microinvolvement. No patients with negative sentinel node showed tumor dissemination during follow-up, with a mean of 23.5 months (range 7-44). CONCLUSIONS: Sentinel lymph node biopsy is technically feasible with low morbidity. Sentinel lymphadenectomy may play an important role in the management of high-risk CSCC with clinically non-palpable regional lymph nodes. This technique can help identify patients with regional lymph node metastases who may benefit from complete lymphadenectomy. This improved staging may allow clinicians to better stratify patients who might benefit from adjuvant therapy.

Mapeo linfático y biopsia del ganglio centinela en pacientes con carcinoma epidermoide cutáneo de alto riesgo / Lymphatic mapping and sentinel lymph node biopsy in patients with high risk squamous cell carcinoma of the skin

Introducción: Un subgrupo de pacientes con carcinoma epidermoide cutáneo (CEC) tiene alto riesgo de presentar metástasis ganglionares regionales. El mapeo linfático y biopsia del ganglio centinela (MLBGC) ha sido exitosamente utilizado para evaluar la presencia de metástasis ganglionares subclínicas en diversos tumores. bjetivo: Evaluar la utilidad de la técnica del MLBGC en los pacientes con CEC de alto riesgo para detectar la presencia de metástasis ganglionares regionales subclínicas. Material y métodos: De enero 2002 a marzo 2004, un total de 20 pacientes con CEC de alto riesgo con ganglios linfáticos regionales clínicamente no palpables fue evaluado con linfografía preoperatoria y MLBGC. Resultados: En 1 de cada 5 pacientes (20 %), el ganglio centinela reveló la presencia de micrometástasis. Ningún paciente con GC negativo manifestó progresión tumoral ganglionar regional durante un seguimiento medio de 23.5 meses (rango de 7 a 44 meses). Conclusiones: El MLBGC fue técnicamente posible con baja morbilidad. El MLBGC puede tener un importante papel en el tratamiento de los pacientes con CEC de alto riesgo con ganglios linfáticos regionales no palpables. Esta técnica puede ayudar a identificar los pacientes con metástasis en los ganglios linfáticos regionales que pueden beneficiarse de una disección ganglionar radical. Además provee importante información para utilizar terapias adyuvantes a la cirugía.

BACKGROUND: Some sub-groups of cutaneous squamous cell carcinoma (CSCC) display a higher risk for regional metastasis. Sentinel lymph node staging has been used successfully to evaluate nodal metastasis in selective tumors. OBJECTIVE: Assess the feasibility of sentinel node to detect occult regional lymph node metastasis in high-risk CSCC. MATERIAL AND METHODS: Between January 2002 and March 2004, a total of 20 patients received pre-operative lymphoscintigraphy and sentinel lymphadenectomy for high-risk CSCC with clinically non-palpable regional lymph nodes. RESULTS: In one of each 5 patients (20%), sentinel lymph node showed histological evidence of microinvolvement. No patients with negative sentinel node showed tumor dissemination during follow-up, with a mean of 23.5 months (range 7-44). CONCLUSIONS: Sentinel lymph node biopsy is technically feasible with low morbidity. Sentinel lymphadenectomy may play an important role in the management of high-risk CSCC with clinically non-palpable regional lymph nodes. This technique can help identify patients with regional lymph node metastases who may benefit from complete lymphadenectomy. This improved staging may allow clinicians to better stratify patients who might benefit from adjuvant therapy.

[Thyroidectomy associated with laryngectomy in laryngeal cancer treatment. Is it routinely necessary?]. / Tiroidectomía asociada a laringectomía en el tratamiento del cáncer laríngeo, ¿es necesario efectuaria rutinariamente?

INTRODUCTION: In patients with laryngeal invasive epidermoid carcinoma who are candidates for total laryngectomy, it is recommended to resect en bloc at least half of the thyroid gland on the same side as the laryngeal tumor with the objective of decreasing local recurrence associated with thyroid infiltration. Nevertheless, in the histopathologic analysis of the specimen, a minority of thyroid glands show tumor infiltration. The fact that in these patients even partial thyroid resection is associated with hypothyroidism increased by postoperative radiotherapy is well known. The study was undertaken to determine the frequency of thyroid gland invasion in patients who have undergone total laryngectomy due to laryngeal cancer and its associated factors. MATERIAL AND METHODS: We evaluated the histological results of glands resected en bloc with laryngectomy in patients who underwent total laryngectomy due to laryngeal cancer; the clinical stage was compared to the laryngeal subsite tumor origin. The glandular histological condition was compared to the local recurrence presence (peristomal). RESULTS: Ninety two patients were included, 11 (12%) showed glandular infiltration due to epidermoid carcinoma, all with tumors clinically typified as T3 and T4, 8/11 were transglottic and only 3 (27%) showed subglottic invasion. During follow-up (5-year mean) 17/92 showed peristomal recurrence (18%), only 3 (3%) showed thyroid invasion. Among patients with glandular invasion the peristoma recurrence rate was 27% (3/11). DISCUSSION: The best laryngeal cancer thyroid tumor invasion predictor is the evidence of extralaryngeal extension. Thyroid resection en bloc should not be routinely advised due to the low frequency of glandular infiltration.

[Parathyroid glands radio-guided surgery]. / Cirugía radioguiada de las glándulas paratiroides.

INTRODUCTION: Several advances have been made in the management of hyperparathyroidism. The preoperative sestamibi scan appears to have revolutionized the entire approach to parathyroid surgery including minimally invasive parathyroidectomy. Gamma probe is a useful tool that complements a well performed localization of parathyroid adenomas. METHODS: We conducted a retrospective analysis of the patients submitted to radio-guided parathyroidectomy between January and December 2003 at a Oncology tertiary hospital in Mexico City, for evaluate the results and shows the feasibility of this approach. RESULTS: Six patients was included, all of them referred to the hospital with the diagnosis of bone tumors or with bone disease suggest malignancy. Median serum level of preoperative calcium was 13.18 mg/dl. In all cases the transoperative localization of the affected gland was possible using gamma probe and according with Tc 99m sestamibi scintigraphy imaging. None perioperative deaths reported and there were no recurrent laryngeal nerve injuries neither recurrent hypercalcemia. Median serum level of postoperative calcium was 9.39 mg/dl. There were at histopathological analysis five adenomas and one hyperplasia. CONCLUSIONS: Radio-guided parathyroidectomy is a useful approach for transopertaive localization of the affected gland, we obtained a 100% success rate, according with the histopathologic analysis and the normal postoperative serum calcium level.

[Transverse glossectomy for tongue cancer treatment]. / Glosectomía transversa para el tratamiento del cáncer de lengua.

INTRODUCTION: Standard care of patients with oral tongue-invasive squamous cell carcinoma in early stages is local resection and neck dissection. Traditionally, tumor resection was performed with hemiglossectomy (tongue resection in lingual long axis), which implied morbidity for deglutition and speech. Although surgical margins are sufficient, they are usually larger than necessary. OBJECTIVE: To know functional results and surgical margins in patients with T1-T2 oral tongue cancer submitted to transverse glossectomy (TG). MATERIAL AND METHODS: We analyzed charts of patients with T1-T2 oral tongue squamous cell carcinoma treated by TG during a 2-year period. We studied surgical margins, deglutition, speech intangibility, performance status and patient satisfaction. RESULTS: We included 20 patients: 12 women and eight men, with mean age of 45 years. Tumor-thickness mean was 8 mm; 19 patients showed free tumor margins in definitive histology study with mean of 1.8 cm three-dimensionally. In one patient, frozen sections were free-of-tumor, but definitive study showed a microscopic area of squamous cell carcinoma in surgical margin. All patients preserved > 50% of oral tongue and all showed lingual tip deviation and short tongue. None required nasogastric tube for feeding and speech was intelligible in all patients. CONCLUSIONS: TG provided sufficient surgical margin in all patients in this series without important morbidity and with good functional result; thus, TG is an alternative to classic vertical hemiglossectomy for patients in early stages of tongue mobile cancer.

[Prognostic factors in oropharyngeal cancer]. / Factores pronóstico en cáncer de orofaringe.

INTRODUCTION: Oropharyngeal carcinoma (OFC) is rare in Mexico, it only represents 0.6% of all carcinomas. Treatment alternatives are radiotherapy (RT) or radiotherapy-surgery association and prognosis depends on stage and tumor location. OBJECTIVE: Our objective was to know prognostic factors in patients with OFC treated with RT. MATERIAL AND METHODS: We conducted a retrospective analysis of patients with OFC. Analyzed variables were tumor location, RT technique (with or without field reduction; TRC and TSRC), tumor stage, histologic grade, and macroscopic tumor type. Survival was estimated with Kaplan-Meier method. RESULTS: A total of 70 patients, median age of 62 years, 19 women and 51 men. Locations included 24 tonsil, 35 tongue base, eight soft palate, and three posterior lateral wall. A total of 32 tumors were excrescent and 38, ulcer infiltrating, 81% T3-T4 and 18% T1-T2. RT median dose was 5,625 rads; 51 were treated with TSRC and 19 with TRC. Local-regional control was achieved in 35 patients (50%), mortality secondary to treatment was 12.9% whit there were 5-year overall survival. Loco-regional recurrence was 44%. Most frequent morbility for treatment was dysphagia (66%). Variables with statistical survival significance were TRC (18% vs. 53% p = 0.0012), stage (T1-2 vs. T3-4; 58% vs. 21% p = 0.0025, and tonsil location (43% vs. 24% p < 0.005). OFC diagnosis is usually made in advanced stages. Survival prognostic factors are tumor location, tumor stage, and RT technique.