Malignant carotid body tumors: report of three cases.

The aim of the current report was to describe 3 cases of malignant carotid body tumor (CBT) and to review the literature. My clinical records of 87 CBTs in 81 patients (6 bilateral) were reviewed, 79 of which were operated on. Three malignant cases were found. The first was in a 40-year-old man who presented with pulmonary metastases 6 years after resection of a CBT. He was treated with chemotherapy and interferon, but died with disseminated disease 2 years later. The second case was in a 56-year-old woman who had a 5-cm, fixed, hard mass in the upper aspect of the neck and a paralysis of the left vocal cord. This lesion was completely resected, and a shunt and reconstruction with a saphenous vein graft were performed. Pathology revealed a malignant chemodectoma with invasion to 2 of the 5 lymph nodes removed. Radiotherapy (50 Gy) was given after the operation. She is well and free of disease 68 months after the resection. The third case was in a 61-year-old woman who presented with an 8-cm nontender, hard, immobile mass in the left upper neck that displaced the left wall of the oropharynx toward the midline. A carotid arteriogram showed a CBT. On computed tomography, the tumor extended to the infratemporal fossa with no bone involvement. The lesion was embolized with a 40% reduction in vascularity. At surgical exploration, the tumor involved the sternocleidomastoid muscle and the lymph nodes at levels II and III, and the internal carotid artery could not be dissected free at the skull base, so only a partial resection was performed. This patient was lost to follow-up. These 3 cases are in agreement with the literature. Locoregional control is usually obtained with complete primary tumor resection and lymphadenectomy and eventual radiotherapy. Surgery with radiotherapy seems to be effective for isolated metastases. Current multidisciplinary treatments have been unsuccessful in controlling disseminated disease.

Anaplastic thyroid carcinoma in ecuador: analysis of prognostic factors.

The highest incidence of anaplastic thyroid carcinoma (ATC) has been reported in countries with endemic goiter, such as in Ecuador. In this country, ATC is the third most common histologic type of thyroid cancer, following papillary and follicular carcinoma. The aim of this study was to review the clinical presentation and the results of treatment of a large consecutive series of ATC patients treated at the oncological department of a general hospital in Quito, Ecuador. This is a retrospective study of 30 patients diagnosed with ATC at the Social Security Hospital, from 1982 to 1998. Symptomatic rapidly growing neck masses were generally present. All the patients had histological diagnosis of ATC. Two patients with pulmonary metastases and pleural effusion died before treatment could be instituted. Twenty-eight patients received at least one type of treatment: surgery, radiation therapy (RT), or chemotherapy (CT). The two most frequently employed therapeutic modalities were surgery followed by RT and/or CT in 14 patients and surgery alone in 9 patients. Surgery was performed in 23 patients but a complete resection was possible in only 14 patients. RT, postoperatively or alone, was given to 17 patients. Only 5 patients received doses ranging from 4,000 to 5,000 cGy and 4 patients more than 5,000 cGy. CT was administered to 17 patients. Doxorubicin alone was given to 10 patients and different combinations to the remaining patients. Local control was obtained in 8 of 14 complete resections. The prognostic value of the following parameters was studied by univariate analysis: duration of symptoms, size of the tumor, extent of glandular involvement, type of treatment, and surgical margins. A statistically longer survival was found in cases of differentiated carcinoma with areas of ATC or tumor limited to one lobe, those patients who received a complete treatment of chemotherapy, and those patients with tumors smaller than 10 cm and with duration of symptoms longer than 4 months. Longer mean survivals were seen in patients with longer duration of symptoms and smaller lesions. Five patients with focal anaplastic lesions within a differentiated thyroid carcinoma or a lesion limited to one lobe had a significant better survival (a mean of 20 months).

Malignant salivary gland tumors in Quito, Ecuador.

OBJECTIVES: Malignant salivary gland tumors (MSGT) are uncommon. Age-standardized incidence rates are 0.5 and 0.3 per 100,000 in Quito, Ecuador; and 1.0 and 0.7 per 100,000 in the USA (SEER Program), for males and females, respectively. The goal of this study was to review a 16-year experience of a major general hospital in the treatment of these lesions. PATIENTS AND METHODS: From 1982 to 1998, 308 salivary gland tumors were surgically treated at the Hospital 'Carlos Andrade Marin' of the Ecuadorian Institute of Social Security in Quito, Ecuador, an Andean city of approximately 2 million inhabitants. Malignant lesions were found in 58 cases (19%): 37 out of 194 parotid gland tumors (19%), 7 out of 86 submandibular tumors (8%) and 14 out of 28 minor salivary gland tumors (50%). Adenoid cystic carcinoma and mucoepidermoid carcinoma were the most common histologic types. Twenty-two cases were classified as stage I, 13 as stage II, 1 as stage III and 20 as stage IV (UICC TNM staging classification). Thirty-one (53%) patients were treated by surgery alone; postoperative radiation therapy was additionally given to 22 (38%), and surgery, radiotherapy and chemotherapy were applied in 5 cases (9%). RESULTS: Local (LR) and/or regional recurrences were detected in 13 patients (22%). Twelve patients (21%) developed distant metastasis (DM; 2 in more than one site): 7 in the lungs, 2 in the brain, 2 in the bone and 1 each in the liver, subcutaneous tissue and pleura. Thirty-five patients are alive, 33 disease free. Twenty-three patients are deceased: 6 with LR, 7 with DM, 3 with both LR and DM, 1 with locoregional recurrence and DM, 2 with a second neoplasm, 3 with intercurrent disease and 1 from unknown causes. Five- and 10-year overall survival rates were 75 and 68%, respectively. There were no significant differences in mortality according to the site of the primary tumor or histologic type, but stage and involved surgical margins were important prognostic factors (p = 0.006 and 0.003). CONCLUSIONS: The surgical or multimodality treatment of MSGT has provided a good locoregional control (78%) and 68% 10-year survival in a series of patients treated at the oncology department of a general hospital in Quito, Ecuador. Stage and involved surgical margins were significant prognostic factors.

[Thyroglossal duct cysts]. / Quistes del conducto tirogloso.

INTRODUCTION: A thyroglossal cyst (TGC) is an unusual neck lesion that is occassionally diagnosed in a general hospital that mostly attend adult patients. The aim of the current study was to analyze our experience in the management of these lesions. MATERIAL AND METHODS: The records of 43 patients operated on at the Social Security Hospital in Quito (Ecuador) from 1980 to 1998 for a thyroglossal duct cyst or fistula, were reviewed. RESULTS: Distribution was similar in both sexes. Mean age was 23. Thirty-five patients presented with a cystic lesion located in the midline or slightly laterally in the neck, closely related to the hyoid bone; the other 8 patients had a cutaneous fistula at the same place. All of the patients but one, underwent a radical Sistrunk procedure; complications were minor. In 5 patients (12%), a papillary thyroid carcinoma within the TGC was reported at the histologic study. No recurrence developed after a mean 23-month follow-up. CONCLUSIONS: A cyst or a fistula located at the level of the hyoid bone suggest a thyroglossal duct lesion. A papillary carcinoma can rarely occur within the TGC. A Sistrunk procedure is usually curative.

[Cancer of the larynx in Ecuador]. / Cáncer de laringe en Ecuador.

A retrospective review was made of 75 cases of laryngeal cancer evaluated and treated at the Social Security Hospital of Quito (Ecuador). No exclusively supraglottic lesions were found; 67% of cases, were glottic or glottic-supraglottic. Thirty-two per cent of cases were T1 and T2 and 23% had palpable lymph nodes in neck. Most T1 and T2 tumors were treated with radiotherapy (RT) and most T3 and T4 tumors with a combination of surgery and RT. The 5 and 10-year overall survival rates were 55% and 47%, respectively. The 5-year survival rates were: 81% for T1 and T2 tumors and 36% for T3 and T4 tumors (p = 0.0008), 76% for N- and 42% for N+, 53% for well-differentiated and 58% for moderately or poorly differentiated tumors, 85% for T1 and T2 lesions treated with RT and 67% for T1 and T2 lesions treated with partial surgery, and 14% for T3 and T4 lesions treated with RT and 49% for T3 and T4 lesions treated surgically (non-significant differences).

Salvage surgery by composite resection for epidermoid carcinoma of the tonsillar region.

Radiation therapy has usually been used as the primary treatment of squamous cell carcinoma of the posterior aspect of the oral cavity and the lateral aspect of the oropharyngeal walls. However, local failure occurs in a certain number of cases, depending on the initial tumor stage. One hundred thirty-four composite resections (transmaxillary buccopharyngectomies) have been performed as a salvage treatment at the Institut Gustave-Roussy, Villejuif, France, from January 1, 1976, through December 31, 1985, for local failure of epidermoid carcinomas treated initially by radiotherapy. Average time between primary irradiation and salvage surgery was 18 months. Most of the patients underwent some kind of supraomohyoid neck dissection. A myocutaneous flap was used in 18% of cases, which significantly reduced the rate of local complications. The nasogastric tube and the tracheostomy cannula were removed after a median delay of 23 days and 24 days, respectively. Early postoperative local complications occurred in 45% of cases; most of them were minor. A new locoregional recurrence occurred in approximately half of the patients and was usually fatal. Overall survival after salvage surgery was 34% at 3 years and 23% at 5 years. The only statistically significant prognostic factor was the adequacy of surgical margins.

Squamous cell carcinoma of the upper aerodigestive tract associated with well-differentiated carcinoma of the thyroid gland.

The association of squamous cell carcinoma of the upper aerodigestive tract with well-differentiated thyroid carcinomas has rarely been reported in the literature. We report 10 cases illustrating this occurrence. In eight cases, the thyroid carcinoma was discovered accidentally on histological examination of a single neck node, a neck node dissection specimen, an unexpectedly found thyroid nodule, or a systematically resected thyroid lobe, all during surgical treatment of an upper aerodigestive tract carcinoma. In the other two cases, metastatic thyroid neck nodes appeared during the follow-up of a patient with an upper aerodigestive tract carcinoma. No case of upper aerodigestive tract carcinomas was found during the follow-up of thyroid cancer patients. In most cases, adequate thyroid cancer surgery was performed simultaneously or later. Prognosis was essentially determined by the upper aerodigestive tract cancer.

Papillary carcinoma in thyroglossal duct remnants.

About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world literature. Five additional cases were discovered incidentally on histopathological examinations of specimens following Sistrunk's operation for removal of thyroglossal cysts and are now reported. The possibility of preoperative clinical diagnosis and the modalities of treatment are discussed.

Malignant tumours of the parotid: a study of 76 patients.

This study presents a series of malignant parotid tumours treated at the Institut Gustave-Roussy between 1975 and 1984. The lesions represented a wide variety of histological types. Few preoperative investigations were required, management being based on histology. Effective local control requires a total parotidectomy preserving the facial nerve where possible. It should be followed by routine radiotherapy which appears to reduce the incidence of local recurrence. The rate of local recurrence also depends on the histological type. It is seen more frequently in an adenocarcinoma following a pleomorphic adenoma than in simple adenocarcinoma. Patients with inoperable disease are treated with radiotherapy alone as chemotherapy has not so far been effective. Percentage 5-year survival for the three most common tumour types is as follows: adenocarcinoma: 49; adenoid cystic carcinoma: 83, and mucoepidermoid carcinoma: 75.