Risk factors for oral mucositis in patients with solid tumorsunder treatment with cetuximab: a retrospective cross-sectional study

Background: This study retrospectively analyzed the risk factors for oral mucositis (OM) during cetuximab treatment. Material and Methods: We screened patients using cetuximab and retrospectively evaluated the presence of OM based on medical records. We collected information from 2 years of evaluations. Patient medical records were reviewed to obtain data on chemotherapy cycle and dose, sex, age, primary tumor, TNM stage, and head and neck radiotherapy (HNR) history. The X2 test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). Results: Among 1831 patients, OM was showed in 750 in any grade (41%), during cetuximab treatment. Most patients were female (n=944, 51.6%), <70years-old (n=1149, 62.8%), had larynx cancer (n=789, 43.1%) in T4 (n=579, 47.7%), N0 (n=509, 52.6%) stages. Primary tumor surgery was performed in 1476 (80.6%) patients, radiotherapy in 606 (33.1%) patients and cetuximab protocols most used involved up to four cycles (n=1072, 58.5%) of <400mg (n=996, 54.4%) cetuximab doses. Female (OR [odds ratio] = 2.17, CI95% = 1.26-3.75), >70 years-old patients (OR = 16.02, CI95% = 11.99-21.41), with HHNR (OR = 1.84, 1.41-2.40), treated with >4 cycles (OR = 1.52, CI95% = 1.16-2.01) and high doses of cetuximab (OR = 3.80, CI95% = 2.52-5.71) are the greatest risk factors for OM. Conclusions: Since the clinical benefit of cetuximab in the treatment of older patients is limited and there is a high OM, especially in women with head and neck treated with radiotherapy, high doses and a high number of cetuximab cycles must be administered with caution. (AU)

Incidence and profile of benign epithelial tumors of salivary glands from a single center in Northeast of Brazil

BACKGROUND: Benign tumors of the salivary glands are a group of lesions with varied histopathological and clinical spectrum. The aim was to determine the incidence and clinicopathological characteristics of benign salivary gland neoplasms diagnosed between 2007 and 2016 in a single center located in northeastern Brazil. MATERIAL AND METHODS: Records regarding sex, age, anatomical location, histopathological subtype and treatment were retrieved, and data were analyzed using the Stata/IC software (version 12.0). RESULTS: There were above 7,100 cases of neoplasms in the head and neck region, of which 403 corresponded to salivary gland neoplasms. Of these, 238 (59%) were benign, being pleomorphic adenoma (PA) the most frequent neoplasm (n=178; 74.8%), followed by Warthin's tumor (WT) (n=23; 9.7%). Overall, most cases occurred in females (n=136; 57.1%) and age ranged from 11 to 83 years. The parotid gland (n=188; 79%) was the most common anatomical site, and all patients were treated by surgical excision. Of the cases diagnosed as PA, malignant transformation to carcinoma ex-pleomorphic adenoma (CAEXPA) occurred in 7 (3.9%) cases. CONCLUSIONS: The present study confirmed the clinical and demographic profile of benign salivary gland neoplasms, which contributes to the continuous knowledge of current data about these lesions

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Warthin-like, una variante infrecuente del carcinoma papilar de tiroides / Warthin-like, a rare variant of papillary thyroid cancer

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Revisiting Dukes’ paradigm; some node positive colon cancer patients have better prognosis than some node negative patients

Background: The current study tried to evaluate the prognostic value of a modified staging system compared to the American Joint Committee on Cancer (AJCC) staging system for patients with colon cancer. Patients and methods: Surveillance, epidemiology and end results (SEER) database (2004-2014) was queried through SEER*Stat program and AJCC 7th stages were constructed. Through recursive partitioning analysis and subsequent decision tree formation, suggested new stages were formulated based on T and N descriptors. Overall survival analyses were performed through Kaplan-Meier analysis. The cancer-specific Cox regression hazard (adjusted for age, gender, sub-site, grade, race and surgery) was calculated and pair wise comparisons of hazard ratios were conducted. Results: A total of 159,683 non-metastatic patients with colon cancer were recruited in the analysis. Pair wise hazard ratio comparisons among different AJCC 7th stages were conducted and all comparisons were significant (P < 0.0001). However, it should be noted that the adjusted risk of death among stage IIC patients was higher than stage IIIA and IIIB. Pair wise hazard ratio comparisons among different modified system stages were also conducted and all comparisons were significant (P < 0.0001). The outcomes of survival analysis were the same regardless of the number of examined lymph nodes (< 12 vs. ≥ 12). Concordance index (using death from colon cancer as the dependent variable) for AJCC 6th staging system was 0.704 (SE 0.002; 95% CI 0.701-0.708); for AJCC 7th staging system was 0.708 (SE 0.002; 95% CI 0.704-0.711); for Dukes staging system was 0.670 (SE 0.002; 95% CI 0.666-0.674); and for modified staging system was 0.712 (SE 0.002; 95% CI 0.709-0.716). Conclusion: The proposed modified staging system provided an improved prognostication for colon cancer patients (particularly for stage II/III disease) compared to AJCC staging system. Further external validation of the proposed staging system is needed before adoption into routine practice

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Carcinoma papilar de tiroides variante Warthin-like / Warthin-like variant of thyroid papillary carcinoma

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Aneurisma intraparotídeo de vena comunicante posterior / Intraparotid aneurysm of the posterior communicating vein

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Tumors of the salivary gland in Mexicans. A retrospective study of 360 cases

Objective: To establish distribution frequency and demographic characteristics of salivary gland tumours (SGT)in order to identify possible risk profiles. Design of study: The present report constitutes an eight year retrospective study (January 2000-August 2007). The archives of the Clinical and Experimental Pathology Laboratory (Graduate and Research Division, Dental School, National Autonomous University of Mexico) as well as archives of the Surgical Pathology Service (General Hospital, Mexico City) were subject to revision in order to select all cases where SGT tumour diagnoses were emitted. Age and gender of patients as well as SGT topography were obtained from medical records. Selected cases were classified according to location of the lesion, histological lineage and biological behaviour. Results: 360 cases of SGT were included, 227 (67%) cases were benign tumours, while 83 cases (23%) were malignant tumours. SGT were most frequent in women with ages ranging from their 3rd to 5th decades of life.275 tumours were located in major salivary glands, 78.9% of them were identified in the parotid gland. The most frequent location of tumours arising from minor salivary glands (33 cases, 38%) was found in the palatine glands. Tumours of epithelial lineage were the predominant histological type. The most frequent benign tumours were pleomorphic adenomas (86.1%) and papillary cyst adenoma lymphomatosum (7.3%). The most frequent malignant tumours were adenoid cystic carcinomas (25%) and mucoepidermoid carcinomas (23.6%) (AU)

Tumor de Warthin gigante / Giant Warthin tumour

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Expresión de SDHB en el tumor de Warthin / SDHB expression in Warthin’s tumour

Introducción: El objetivo del presente estudio es analizar la expresión de la succinodeshidrogenasa B (SDHB), enzima perteneciente al complejo mitocondrial II, en el tumor de Warthin analizando su relación con los cambios oncocíticos, un dato morfológico constante en este tipo tumoral. Material y métodos: En una serie de 10 tumores de Warthin, todos parotídeos, se analizó en los especímenes de resección tumoral la expresión de SDHB utilizando un anticuerpo monoclonal comercializado. Resultados: Los 10 tumores afectaron a 10 varones (edad media: 64, 2 años; rango: 40-80), todos ellos con antecedentes de hábito tabáquico, y 2 con afectación bilateral metacrónica. Dos pacientes presentaron de forma asociada carcinomas del tracto urotelial. El estudio de la SDHB mostró en todos los casos acusada reactividad (++/+++) del componente epitelial oncocítico, así como del citoplasma de los conductos estriados del tejido parotídeo no tumoral. Esta expresión no se vio influida por el rango de edad, la intensidad del hábito tabáquico, ni por el carácter bilateral de los tumores. Uno de los tumores presentó focos de metaplasia escamosa con negatividad a la SDHB en esa localización. Discusión y conclusiones: La constante e intensa reactividad de la SDHB encontrada en nuestras observaciones, en las células oncocíticas, orienta a considerar que los cambios oncocíticos en el tumor de Warthin no se asocian a una actividad enzimática defectiva en este componente del complejo mitocondrial II. La reactividad de SDHB se conforma como un marcador adicional de la diferenciación oncocítica existente en el caso del tumor de Warthin, aspectos ambos previamente no descritos (AU)

Introduction: Succinic dehydrogenase subunit B (SDHB) is an enzyme belonging to the mitochondrial complex II. The aim of this study is to analyse SDHB expression in a series of Warthin’s tumours, studying its relationship with oncocytic changes, constantly present in this form of tumour. Material and methods: In resection tumour specimens from a series of ten Warthin’s tumours (all from the parotid gland), immune histochemical expression of SDHB was analysed using a commercially-available monoclonal antibody. Results: The Warthin’s tumours studied affected 10 men (mean age: 64.2 yrs, range 40-80), all with smoking habits, and 2 with metachronous bilateral involvement. Two patients presented associated urothelial carcinoma. Our SDHB study showed marked reactivity (++/+++) in all cases in the oncocytic epithelial component and also in striated duct cytoplasm (+) from non-tumorous parotid tissue. Expression was not influenced by age, smoking intensity or bilateral character. One of the tumours showed squamous metaplasia foci with SDHB-negativity at this level. Discussion and conclusions: Due to the constant and intense SDHB reactivity in oncocytic cells in our observations, oncocytic changes are not considered to be associated with defective enzyme activity in the mitochondrial complex II. Strong SDHB reactivity is an additional marker of oncocytic changes in Warthin’s tumour. Neither of these facts has been described previously (AU)

Trece años de experiencia en parotidectomía parcial superficial como tratamiento de neoformaciones benignas parotídeas / Thirteen years’ experience with partial superficial parotidectomy as treatment for benign parotid tumours

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Trece años de experiencia en parotidectomía parcial superficial como tratamiento de neoformaciones benignas parotideas / Thirteen years’ experience with superficial partial parotidectomy as treatment for benign parotid tumours

Introducción: La mayoría de los autores aceptan la cirugía como tratamiento de elección para los tumores benignos de parótida. La mejor técnica quirúrgica o el grado de extensión de la cirugía permanecen controvertidos. El presente estudio pretende comprobar si la parotidectomía parcial superficial (PPS) es adecuada para el tratamiento de los tumores benignos de glándula parótida. Material y métodos: Seleccionamos 63 pacientes con tumor benigno, operados de glándula parótida, 43 tenían un adenoma pleomorfo y 20 un tumor de Warthin. De este grupo de 63 pacientes no se pudo incluir a 6 (3 fallecidos y 3 no localizados). Estudiamos a 57 pacientes, 41 diagnosticados de adenoma pleomorfo y 16 de tumores de Warthin. En todos ellos realizamos PPS sin monitorización del nervio facial. Resultados: Parálisis transitoria del nervio facial 14 pacientes (24,5%). Diez se resolvieron antes del primer mes y cuatro antes del tercer mes. Un paciente (1,7%) sufrió una dificultad definitiva para mantener alineado el hemilabio inferior en la movilidad forzada, sin alteración en la movilidad de la comisura. Ninguna recidiva (control entre 3 y 13 años). Conclusiones: La PPS es una técnica con unas complicaciones y una tasa de recidivas comparables o menores que otras técnicas empleadas para el tratamiento de adenomas pleomorfos o tumores de Warthin parotídeos. La monitorización del nervio facial puede ser una ayuda durante el acto quirúrgico. La falta de monitorización no sería considerada una contraindicación para la realización de la cirugía (AU)

Introduction: Most authors agree that surgery is the treatment of choice for benign tumours of the parotid gland. However, the best surgical technique and the extent of surgery remain controversial. This study attempts to establish whether the implementation of a partial superficial parotidectomy (PSP) is appropriate for the treatment of benign parotid gland tumours. Material and methods: We selected 63 patients with benign parotid gland surgery, of whom 43 had a pleomorphic adenoma and 20, a Warthin tumour. Of this group of 63 patients, 6 could not be included. We consequently studied 57 patients, 41 of them diagnosed as pleomorphic adenoma and 16, as Warthin tumours. In all of them, a PSP was performed without intraoperative monitoring of the facial nerve. Results: Transient facial nerve paralysis, 14 patients (24.5%). Ten cases were resolved within the first month after surgery and 4 before the third month, after indicating facial physiotherapy. One patient (1.7%) had a permanent difficulty in keeping one side of the lower lip aligned under pressure-mobility, without altering commissure mobility. None of the patients studied had a recurrence (control, 3-13 years). Conclusions: Although PSP is a technique with a few complications, it has a recurrence rate comparable to or lower than other techniques used for the treatment of pleomorphic adenomas or Warthin parotid tumours. Intraoperative facial nerve monitoring can be helpful during surgery. The lack of monitoring would not be considered a contraindication for surgery (AU)

Neoplasms of the salivary glands in a Turkish adult population

Objective: This retrospective study aimed to investigate the types and distribution of neoplasm of salivary glandsin a Turkish population.Study Design: The histological diagnosis records of the Department of Pathology at Cumhuriyet University were reevaluated for 125 patients who were treated for salivary gland tumors from 1987 to 2008. The neoplasms were analyzed for histological diagnosis, age, sex, and site. The histological diagnoses were analyzed according to the2005 WHO classification.Results: A total of 125 primary salivary gland neoplasms, consisting of 95 (76%) benign and 30 (24%) malignant groups were recorded. The most common major and minor salivary gland sites were the parotid (61.6%) and palatalglands (9.6%), respectively. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin’stumor. Among the malignant group, adenoid cystic carcinoma was the most prevalent. Age for all cases rangedfrom 16-80 years; mean age was 41.97 years, with a female to male ratio of 1:1.15.Conclusions: Although there were some discrepancies, the characteristics of salivary gland tumors of Turkish patients are in line with those of patients from other countries according to tumor type, tumor site distribution,and age and sex of patients (AU)

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Correlación citohistológica en tumores de la glándula parótida / Cyto-histological correlation in parotid gland tumors

Objetivo: Evaluar la eficacia de la citología por punción aspiración con aguja fina (PAAF) en el diagnóstico de malignidad de los tumores de la glándula parótida con el fin de planificar el tratamiento más adecuado para cada caso. Material y método: Se realiza un estudio retrospectivo en una muestra de 41 pacientes, en el que se evalúa la correlación entre la PAAF y los hallazgos histopatológicos de la pieza quirúrgica de los tumores de la glándula parótida, realizadas entre los años 2004 y 2008. Resultados: La sensibilidad de la PAAF para detectar malignidad fue de un 71% y la especificidad de un 91%, con un valor predictivo positivo de 62,5% y un valor predictivo negativo de 93,7%. La tasa de falsos negativos fue de 29% mientras que la de falsos positivos de 9%. Conclusiones: La PAAF es un procedimiento diagnóstico de gran utilidad en el diagnóstico de malignidad de tumores de la glándula parótida, que permite establecer el tratamiento más adecuado e individualizado para cada paciente. No obstante, no está exenta de limitaciones en cuanto a su precisión diagnóstica (AU)

Objective: To evaluate the usefulness of fine needle aspiration biopsy (FNAB) in the study of parotid gland tumour malignancy in order to plan the most suitable treatment in each case. Material and Method: a retrospective study was made of 41 cases, in which we evaluated the correlation between the FNAB and the histopathological findings of the surgical piece of parotid gland tumours, from 2004 to 2008, as well as the epidemiological information of these patients. Results: The sensitivity of FNAB in the detection of malignancy was 71% and the specificity was of 91%, with a positive predictive value of 62.5% and a negative predictive value of 93.7%. The rate of false negatives was 29% whereas that of false positives was of 9%. Conclusions: The use of the FNAB in the study of parotid gland tumors is a useful and simple tool that guides us in the diagnosis and planning of treatment. Nevertheless, it is not exempt from limitations in its diagnostic accuracy (AU)

Manejo de la patología quirúrgica de la glándula parótida: revisión de 54 casos / Management of the surgical pathology of the parotid gland: A review of 54 cases

Introducción y objetivos: El abordaje de la patología quirúrgica de la glándula parótida y los resultados obtenidos son relativamente uniformes. Sin embargo, tanto en la vertiente diagnóstica como en la terapéutica, existen algunos aspectos controvertidos cuya discusión planteamos a partir de la experiencia reciente de nuestro servicio. Métodos: Se realizó un estudio descriptivo retrospectivo sobre pacientes sometidos a parotidectomía por cualquier indicación entre julio de 2004 y junio de 2009 (5 años). Resultados: Se realizaron 54 parotidectomías en 52 pacientes. La TC fue el estudio de imagen preoperatorio más utilizado. La validez de la PAAF fue del 93,3%. El 76% fueron procesos benignos; entre ellos el 7,3% de causa inflamatoria. Todas las intervenciones se realizaron con monitorización electrofisiológica del nervio facial a partir de abril de 2005. Se realizó parotidectomía superficial en el 75,6% de los procesos benignos. La incidencia de paresias faciales transitorias en patología benigna fue del 14,6% (todas grados II y III). Dos casos (ambos con parotidectomía total) tuvieron secuelas permanentes de movilidad facial. La incisión de ritidectomía se utilizó preferentemente en mujeres jóvenes. Conclusiones: Identificamos como puntos de controversia, bien por discrepancia con la evidencia científica o por evidencia insuficiente: el papel diagnóstico de la RM, la validez y utilidad de la PAAF, las indicaciones del tratamiento quirúrgico, la necesidad de monitorización del nervio facial, y la consideración de los aspectos cosméticos, en particular las indicaciones de la incisión de ritidectomía (AU)

Introduction and aim of the study: The management of the surgical pathology of the parotid gland and its results are relatively uniform. However, both in the diagnostic and the therapeutic aspects, there are some controversial issues which we discuss from the point of view of recent experience at our department. Methods: A descriptive and retrospective study was conducted on patients who underwent parotidectomy for any indication between July 2004 and June 2009 (5 years). Results: Fifty four parotidectomies were performed in 52 patients. CT was the most commonly used preoperative diagnostic imaging study. The accuracy of FNAB was 93.3%. 76% were benign processes; among them 7.3% with inflammatory causes. All of the surgical procedures from April 2005 onwards were performed with electrophysiological monitoring of the facial nerve. Superficial parotidectomy was performed in 75.6% of benign cases. The incidence of transient facial paresis in benign pathologies was of 14.6% (all of them of grades II and III). Two cases (both with total parotidectomy) had permanent facial mobility sequelae. The rhytidectomy incision was used preferentially in young women. Conclusions: The controversial issues identified, due either to discrepancies or lack of enough evidence, were: the diagnostic role of MRI, the validity and usefulness of FNAB, the indications of surgical treatment, the need for facial nerve monitoring and the consideration of cosmetic aspects, in particular the indications of rhytidectomy incision (AU)

Parotidectomías en tumores benignos: clasificación "Sant Pau" de la extensión de la resección / Parotidectomies in benign parotid tumours: "Sant Pau" surgical extension classification

Introducción y objetivos: En la actualidad coexisten diferentes opciones para tratar un tumor benigno de la glándula parótida, lo que ha llevado a una cierta confusión sobre la extensión de la resección que se realiza en cada caso. Para intentar mejorar dicha información, se creó en nuestro servicio un sistema de clasificación por áreas para definir la parte extirpada. Se empezó a utilizar en julio de 2006 y en este artículo se revisa su aplicabilidad y utilidad. Métodos: Se analizan 44 pacientes operados en nuestro servicio de tumores clínicamente benignos de la glándula parótida, en el periodo comprendido entre julio de 2006 y diciembre de 2008. A todas las resecciones se les aplicó el sistema de clasificación de nuestro centro, que divide la parótida en 5 áreas: I (lateral craneal), II (lateral caudal), III (profunda craneal), IV (profunda caudal), V (accesoria). Resultados: La clasificación ha sido de fácil aplicación y no ha presentado ningún problema práctico en los 44 pacientes operados. Al analizar las áreas resecadas en la cirugía, destaca el alto porcentaje (47%) de parotidectomías laterales parciales caudales (resección del área II). La parotidectomía lateral (resección áreas I–II) ha sido la segunda en número con 14 casos (33%). El 20% restante se ha repartido entre las demás opciones. Conclusiones: El sistema de clasificación por áreas ha permitido definir con claridad la cirugía realizada en cada caso y ha permitido explicar de forma fácil la resección realizada, incluso en aquellos casos de resecciones poco habituales (AU)

Introduction and goals: At present different options co-exist for treating a benign tumour of the parotid gland, which has led to some confusion about the extent of resection performed in each case. In an effort to improve this situation, we created a classification system to define the areas removed. We started using this classification in July, 2006, and this article reviews its applicability and usefulness. Methods: We analyzed 44 patients who underwent surgery for clinically benign tumours of the parotid gland in our department between July, 2006, and December, 2008. In all resections, our classification was applied, dividing the parotid gland into five areas: I (lateral superior), II (lateral inferior), III (deep superior), IV (deep inferior), V (accessory). Results: The classification was easily applied and has presented no practical problem in the 44 patients operated. When analyzing the areas excised in surgery, the most common surgery was lateral inferior partial parotidectomy (removal of area II) in 47% of the cases. Lateral parotidectomy (removal of areas I and II) was the next most frequent, with 14 cases (33%). The remaining 20% was distributed among the other options. Conclusions: Our classification system appears to be a simple and easy way to define the surgery performed in each case, which simplifies the description of the resection performed, even in unusual resections (AU)

Papillary cystoadenoma lymphomatosum (Warthin-like)of minor salivary glands

Papillary cystadenoma lymphomatosum is a benign salivary gland tumor most frequently located in the parotidgland (Warthin’s tumor). Its presentation in other major, or in minor, salivary glands is rare. Clinically, it manifestsas a slow growing tumor, fluctuant on palpation due to its cystic morphology. The treatment of choice is completeexcision with wide tumor-free margins. We present a 73-year-old female patient with an asymptomatic tumor of 8years evolution in the right posterior area of the hard palate. We performed surgical excision and a biopsy, whichwas reported as papillary cystadenoma lymphomatosum. During the post-operative examination carried out after3 weeks, it was observed that the lesion had recurred. The lesion was re-operated, performing the excision withCO2 laser and including the periosteum to ensure complete resection of the tumor. At 10 months follow-up, therewas no recurrence of the lesion. This article includes a review of this condition and discusses its most importantclinical and pathologic features and therapeutic approaches (AU)

Synchronous unilateral parotid neoplasms. A case report

The parotid gland is the most usual location of benign neoplasms affecting major salivary glands and quite oftenthe recurrence of these tumours is noticed, specially in the case of pleomorphic adenoma. The occurrence of multipletumours in the parotid glands is rare and the majority of these are multifocal Warthin`s tumors (papillary cystadenomalymphomatosum). The simultaneous development of tumours with different histological types is unusualand when it occurs, the most common combination is a pleomorphic adenoma and a Warthin`s tumor. There aremany articles about Multiple Parotid Tumors (MPT) but only a few of them are focused on unilateral synchronousbenings tumors, being pleomorphic adenoma and Warthin´s these tumors.The report describes a 55 year old female with a pleomorphic adenoma occurring synchronously with a Warthin`stumor within the superficial lobe of her left parotid gland (AU)

Diagnóstico diferencial de las lesiones quísticas del páncreas / No disponible

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Lymphoid lesions of salivary glands: Malignant and Benign Gary L

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Lesions of salivary glands with a prominent lymphoid component are a heterogeneous group of diseases that include benign reactive lesions and malignant neoplasms. Occasionally, these pathologic entities present difficulties in the clinical and pathological diagnosis and prognosis. Lymphoepithelial sialadenitis, HIV-associated salivary gland disease, chronic sclerosing sialadenitis, Warthin tumor, and extranodal marginal zone B-cell lymphoma are examples of this pathology that are sometimes problematic to differentiate from one another. In this paper the author reviewed the main clinical, pathological and prognostic features of these lesions