Histopathologic features and management of ameloblastoma: study of 20 cases.

BACKGROUND: Odontogenic ameloblastoma (OA) of the jaws is a rare neoplasia of the oral cavity (0.78%) with a 5:1 mandible/maxilla relation, with the molar region and the ascendant ramus being the most affected areas. Comparing our results with the literature demonstrated to us that this tumor may be considered to be a worldwide problem due to the similarity in clinical findings among different ethnic groups CASE SERIES: The purpose of this study of 20 patients with ameloblastoma of the mandible and maxilla diagnosed at the Stomatology and Head and Neck Services of Heliópolis Hospital, São Paulo, Brazil, from 1980 to 1997, was to establish the histopathologic pattern of classification of those tumors through optical microscopy and the relation of this histopathology to therapeutic management. Using the Regeze, Kerr and Courtney classification (1978), we diagnosed follicular tumor in 11 cases, plexiform in 6 cases and unicystic in 3 cases, and performed surgical resection with a safety margin of 1.5 to 3.0 cm in the follicular and plexiform cases and bone curettage in the unicystic cases.

Perioperative frozen section examination in parotid gland tumors.

CONTEXT: The minimal recommended surgical approach to parotid tumors is partial parotidectomy with resection of the superficial lobe of the gland. Histologic diagnosis prior to surgery is not possible, as incisional biopsies are contraindicated due to the possibility of facial nerve injury or incomplete tumor resection. Thus, the biopsies tend to be perioperative. OBJECTIVE: To compare the results of frozen section examination with the definitive pathological diagnosis. DESIGN: Accuracy study by retrospective analysis. SETTING: Head and Neck Surgery Service of Heliópolis Hospital, São Paulo, Brazil. SAMPLE: 153 cases of parotid gland tumors treated between 1977 and 1994. DIAGNOSTIC TEST: Frozen section and pathological diagnosis. MAIN MEASUREMENTS: Sensibility and specificity of the frozen section examination. RESULTS: Frozen section study diagnosed 19 (12.4%) malignant and 127 (83.7%) benign tumors. Sensitivity of the frozen sections for malignancy was 61.5% (95% CI 54 to 69%) and specificity was 98% (95% CI 94 to 100%), and this result is comparable to the literature. CONCLUSIONS: We consider that frozen section examination for salivary gland tumors is not sufficient on its own for deciding on the best management. Their interpretation must be correlated with clinical and intraoperative findings, in association with the surgeon's experience.

The value of therapeutic planning and the degree of experience of the surgical team on the results of cancer treatment of the larynx and hypopharynx.

This is a prospective study supported by 170 cases of epidermoid carcinoma of the larynx or hypopharynx, treated during the period from January of 1981 to January of 1988, at the Head and Neck Surgery Service of the Heliópolis Hospital Complex, São Paulo. The objective of this project was to evaluate the importance of surgeon experience with regard to the rates of post-operative complications and the rates of relapse and survival. The results of the 8 surgical specialists who integrate the permanent staff at the institute and who different varying degrees of experience with regard to time spent exercising their specialties were compared. The results obtained did not show a significant difference among the various surgeons, and this uniformity is explained by the fact that all the therapeutic planning was elaborated through consensus of the whole group, and this could have minimized the effect of experience of a surgeon responsible for the operation. The authors emphasize the importance of pre-operative evaluation for good results and propose that it is in the direction of complete mastery of preliminary work in the area that programs for the formation of new specialists should be directed.

Factors influencing regional lymph node metastasis from laryngeal carcinoma.

A series of 103 cases of laryngeal carcinoma subjected either to a unilateral or to a bilateral comprehensive neck dissection was reviewed with reference to risk factors influencing regional lymph node metastasis. The sensitivity of clinical examination was only 67.4%, while the specificity was 88.3%. Most metastases were in the upper and middle jugular chain of nodes (levels 2 and 3). Only patients with positive nodes at levels 2, 3, and/or 4 had histologically positive nodes at levels 1 or 5. Selected demographic, clinical, and pathologic variables were analyzed with respect to their potential predictive value regarding the risk of histologically proven neck node metastasis. Logistic regression analysis demonstrated that tumor site and histologic grade were the most important predictors of lymph node metastasis. Considering only NO cases, the likelihood of occult metastasis was significantly affected exclusively by tumor site (higher risk for supraglottic lesions).

Lateness of diagnosis of oral and oropharyngeal carcinoma: factors related to the tumour, the patient and health professionals.

The risk of presenting with advanced stage vs. early stage disease was evaluated in a prospective study of 336 consecutive patients with oral and oropharyngeal carcinomas referred to three head and neck surgery services in Sao Paulo, Curitiba and Goiania during the period from February 1986 to December 1988. Income and educational levels were not associated with stage distribution. The risk of having advanced disease was dependent upon male gender. Another important determinant of advanced stage was tumour location on the less visible surfaces of the oral cavity and oropharynx. Although there was a clear increase in delay of referral among cases who were seen by more than one health professional, duration of symptoms and patient and professional delays were not associated with the risk of advanced disease in unifactorial analysis. The following factors were independently associated with the risk of advanced disease for lip carcinoma: a painful ulcer, alcoholism and delay caused by a non-specialist medical doctor. The risk factors associated to advanced oral carcinoma were: type of lesion, odynophagia/dysphagia, delay caused by a dentist and delay caused by a non-specialist medical doctor. Two of the most important immediate consequences of advanced stage were a conspicuous increase in treatment costs and a longer hospital stay.

Prognostic factors in laryngeal cancer patients submitted to surgical treatment.

The authors studied some demographic, clinical, pathologic, and therapeutic variables in relation to the disease-free interval (DFI) and to the overall survival of laryngeal cancer patients. The patient population consisted of 278 consecutive cases of primary laryngeal cancer who had been admitted to four head and neck surgery services in Sao Paulo and Curitiba (Brazil) between 1973 and 1986. All patients had surgical treatment. Although several variables exhibited individual associations with survival, only a few were deemed to have independent prognostic value using multivariate regression techniques based on Cox's proportional hazards model. The primary tumor stage (T index) represented the variable with the highest predictive strength with respect to survival. Hazard ratios for the risk of disease recurrence were 2.3 (T2-3 vs. T1) and 4.3 (T4 vs. T1). Hazard ratios for the risk of death were 1.6 (T2-3 vs. T1) and 3.3 (T4 vs. T1). The following additional factors were also independently associated with the DFI: age, site of primary tumor (transglottic, glottic, or supraglottic), extracapsular spread of lymph node metastasis, surgical margins, type of paratracheal node dissection, and prior tracheostomy. Except for extracapsular spread, the same factors related to the DFI were also significantly related to the overall survival. Race, sex, N-stage, vascular embolization, and histological grade were other independent predictors of the risk of death.

Therapeutic association for nasopharyngeal cancer.

The authors studied retrospectively 16 cases of malignant epithelial nasopharyngeal tumors which were treated at the Head and Neck Service of the Heliópolis Hospital, São Paulo, Brasil, from December 1977 to December 1983. The treatment was intra-arterial chemotherapy (IAC) followed by radiotherapy. The chemotherapeutic schedules were: methotrexate and vincristine, methotrexate, bleomycin and vincristine (2 different schedules) and methotrexate, bleomycin, vincristine and cisplatinum. Objective responses to IAC were observed in 18.6% of the cases. Only 3 patients are alive at 26, 37 and 53 months; 2 of them had exhibited response to IAC. The authors analyze the results and suggest randomized trials in order to determine the exact effects of this method of treatment.

Reconstucao da mandibula por enxerto autogeno de crista iliaca. / Mandibular reconstruction using autogenous iliac bone graft

Os autores apresentam a experiencia do Servico de Cabeca e Pescoco do Hospital Heliopolis em reconstrucao imediata de mandibula com enxerto autogeno de crista iliaca. Sao analisados, pormenorizadamente os 10 casos tratados entre Agosto/1979 e Junho/1982. Apresentam as idversas alternativas de reconstrucao imediatas e tardias da mandibula. Discutem as vantagens e desvantagens de cada metodo, e destacam os resultados dos transplantes osseos autogenos. Discutem os detalhes tecnicos indicacoes e resultados imediatos e tardios das reparacoes com crista iliaca. Concluem que os enxertos autogenos de crista iliaca oferecem bons resultados funcionais e esteticos, e que devem ser indicados nas recosntrucoes mandibulares apos resseccao de neoplasias benignas ou malignas de baixa gravidade

Imagens cintilograficas obtidas apos cateterizacao arterial em tumores de cabeca e pescoco. / Scintigraphic images after arterial catheterization in head and neck tumors

Na utilizacao da quimioterapia antiblastica por via arterial, e de grande importancia o conhecimento do primeiro territorio atingido pelas drogas e que caracteriza este tipo de tratamento. Os autores apresentam um metodo para determinacao do primeiro territorio atingido no tratamento, com a utilizacao de particulas marcadas com radioisotopos. E apresentada a casuistica em tumores da cabeca e pescoco e as imagens obtidas quando do emprego do metodo

Cistos e fistulas branquiais. 2a. parte. / Branchial cysts and fistulae. Part 2

Os autores discutem o desenvolvimento embrionario do aparelho branquial e a fisiopatologia dos cistos e fistulas branquiais. Baseados em 31 pacientes, dos quais foram tratados cirurgicamente 18 casos de cistos e 3 casos de fistulas, fazem referencias a incidencia dessas patologias e ao tratamento administrado. Concluem que os cistos e as fistulas branquiais representam 0,5% das patologias da cabeca e pescoco, que tem carater hereditario e que o tratamento de eleicao e a resseccao cirurgica completa, baseados na embriologia e fisiopatologia dessas afeccoes

Odontogenic adenomatoid tumor of the mandible (adenoameloblastoma).

Adenoameloblastoma may recur when treated incompletely by curettage. In the rare case of recurrence, an extensive and mutilating resection may become necessary. A correct diagnosis must be made in cases of atypical ameloblastomas in order to avoid unnecessary radical surgery. In doubtful cases, biopsy with histopathologic examination is indicated. Acknowledgment: We thank Mrs. Frieda Werebe for organizing this manuscript.

Ewing's sarcoma of the mandible.

Ewing's sarcoma of the head and neck, particularly of the mandible, has a low incidence of occurrence (fifty-five cases in the literature). The present case report demonstrates well the clinical, diagnostic, and therapeutic features in a patient treated at the Head and Neck Service of the Fundação Antonio Prudente, São Paulo, Brazil. The etiologic, clinical, histopathologic, and radiologic features are discussed, with the conclusion that radiation is the best therapeutic procedure when associated with chemotherapy.

[Association of chemotherapy and radiotherapy in the treatment of advanced cancer of the head and neck]. / Association chimio-radiothérapique dans le traitement des cancers avancés de la téte et du cou.

At the Head and Neck and Roentgentherapy Services of Fundaçao Antonio Prudente, São Paulo, Brazil, 38 patients with advanced cancer of the oral cavity and oropharynx, were divided into two groups: the first, submmited to treatment with Bleomycin and Linear Acelerator, and the second to isolated irradiation. Both groups received 7 000 rads in 32 days, and to the association group, Bleomycin was administered in dosis of 300 mgs. The authors concluded that, that Chemo-Radiotherapic association didn't increase the survival rate.