Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases.

Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascularized tumor that affects almost exclusively male adolescents. Surgery is the treatment of choice for JNA. Objectives The present study is a 42-year retrospective review of a series of JNA cases treated surgically without previous embolization. Methods The present is a retrospective, descriptive study based on medical records of 96 patients with JNA who underwent microscopic or endoscopic excision without previous embolization from 1978 to 2020 in a single institution. The patients were categorized according to the Andrews et al. stage, and data were collected on age, gender, tumor staging, surgical approach, affected side, and outcome. Results All patients were male, with an average age of 17 years. The predominant tumor stage consisted of type II, with 52.1%. A total of 33.3% of the patients were submitted to the microscopic technique and 66.7%, to the endonasal technique. The rate of intraoperative blood transfusion was of 17.7%. Conclusion The present study reinforces that resection of JNA in various stages is viable without previous artery embolization.

Prevalence of low back pain in Port of Santos workers.

INTRODUCTION: Low back pain is a common symptom among the general population and among manual workers, contributing to high rates of absenteeism and a decrease in overall quality of life. OBJECTIVES: To determine the prevalence of low back pain in Port of Santos workers, its influence on overall quality of life, physical activity level, and associated absenteeism rate. METHODS: This cross-sectional prevalence study was based on prospective data collection. RESULTS: Eighty-two port workers were interviewed, 97.6% were male, and mean age was 42.9 years. Ethnically, 37.8% reported being brown. Most had completed high school. Longshoreman was the most common occupation, followed by foreman, tallyman, and others. A 44-hour workweek was the most frequent (31.3%), and over 85% of workers reported not working overtime. Most of them were not paid on a production basis. Formal employment, according to Brazilian Labor Law, was 70.7%, and union membership was 64.6%. The mean time working at the port was 11.9 years (standard deviation ± 12.5). Occupational low back pain was reported by 17% of respondents, leading to an absenteeism rate of 19.7%. Physical activities helped improve the feeling of vitality for work performance. CONCLUSIONS: The prevalence of low back pain among respondents was 17%, not influencing their quality of life, with an absenteeism rate of 19.7%. Doing physical activities was common among respondents.

Neck recurrence in papillary thyroid carcinoma.

INTRODUCTION: papillary thyroid carcinoma is a tumor with good prognosis. However, some patients treated present neck recurrence. OBJECTIVE: to evaluate the risk factors for neck recurrence. METHODS: a retrospective study enrolled 89 patients (68 women and 21 men) diagnosed with papillary carcinoma who underwent total thyroidectomy. In 21 patients, neck dissection was performed and 62 patients underwent radioiodinetherapy. Twelve patients relapsed with metastasis in this period with an average of 3.6 years. RESULTS: out of 89 patients, 76.4% were female. Relapse occurred in nine (13.23%) women and three (14.28%) men. The average age of the patients was 44 years in the control group and in patients with relapsed. Eighteen patients (23.37%) in the control group and eight (64.28%) who relapsed had positive lymph nodes at initial diagnosis. The tumor size was significantly larger in the group of patients with cervical recurrence (3.3cm vs. 1.6cm - p=0.008, Student t test), whereas the presence of metastatic lymph nodes at the moment of the first operation was also significant (p=0.004 -Fisher exact test). The tumor size was an independent risk factor for recurrence at the multivariate anaylsis (OR=2.4, IC95%:1.3-4.6 - p=0,007, logistic regression). CONCLUSION: there is an increase in the risk of lymph node recurrence during the follow up of 2.4 folds for each increase of 1cm in the longer nodule diameter.

Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: A systematic review and meta-analysis.

A therapeutic decision in the treatment of Tis/T1a glottic carcinoma with radiotherapy (RT) or transoral laser surgery (TOS) is still an open issue. Oncologic outcome and voice quality may support the choice for the latter To conduct a systematic review and meta-analysis to compare oncologic and functional outcomes of TOS and RT as treatment options for Tis/T1a glottic cancer. Literature research on online databases was carried out. Potentially eligible articles were reviewed. Relevant articles were selected and evaluated. There was statistical significance favoring patients initially treated with TOS when it comes to overall survival, disease-specific survival and larynx preservation. No difference in local control was found. TMF, Jitter and Shimmmer measurements presented statistically significant results in favor of RT. Self-assessment of voice quality (VHI) and f0 showed no statistically significant differences. Maximum Phonation Time (MPT) had a better response to RT. There is a trend in favor of RT. Tis/T1a glottic cancer patients submitted to TOS had significant overall and disease specific survival and had fewer risks of having a total laryngectomy, when compared to the radiotherapy group. The self-assessment of voice quality and f0 did not show any difference; however, Jitter, Shimmer and MPT measurements favored radiotherapy.

Prevalence of cubital tunnel syndrome among dock workers, Saint Sebastian, São Paulo, Brazil.

BACKGROUND: Ports play a substantial role in the Brazilian economy.Despite the large number of port workers, few studies report that the most common musculoskeletal disorders among them involve the upper limbs, including carpal tunnel syndrome, rotator cuff syndrome, cervicalgia and cubital tunnel syndrome.The latter is a neuritis caused by compression of the ulnar nerve at the cubital tunnel (CuTS) on the elbow. OBJECTIVE: To estimate the prevalence of a suggestive diagnosis of CuTS among port workers. METHOD: Seventy-two independent port workers registered with the Labor Management Organ (Órgão Gestor de Mão de Obra - OGMO), Port of Saint Sebastian, were evaluated based on a semi-structured questionnaire and clinical examination, including investigation of pain on palpation of the middle area of the elbow and two maneuvers specific for CuTS, namely, the pressure provocation and maximal flexion tests. RESULTS: The average age of the participants was 48.49 years old, and their average length in the job 23.13 years.Suggestive diagnosis of CuTS was established for five participants.In only two cases elbow pain had begun before, and in three after starting work at the port. CONCLUSION: The prevalence of a suggestive diagnosis of CuTS was 6.9%, and was higher among the participants with longer length in the job (over one year).

INTRODUÇÃO: Os portos brasileiros têm um papel importante na economia do país.Apesar de haver um número expressivo de trabalhadores, existem poucas pesquisas disponíveis envolvendo o ambiente portuário que relatem que as doenças musculoesqueléticas mais recorrentes correspondem as dos membros superiores, como síndrome do túnel do carpo, síndrome do manguito rotador, cervicalgia e síndrome do túnel cubital, esta definida como uma neurite causada por uma compressão do nervo ulnar no túnel cubital na região do cotovelo. OBJETIVO: Estimar a prevalência sugestiva da síndrome do túnel cubital no ambiente portuário. MÉTODO: Foram avaliados 72 trabalhadores portuários avulsos do OGMO do Porto de São Sebastião, São Paulo, por meio de um questionário semiestruturado, o exame clínico que incluiu a pesquisa de dor à palpação na região medial do cotovelo e a realização de duas manobras específicas para síndrome do túnel cubital, o teste provocativo de pressão e o teste de flexão máxima. RESULTADOS: A idade média foi de 48,49 anos e um tempo médio de 23,13 anos de trabalho no porto; a síndrome do túnel cubital teve diagnóstico sugestivo em cinco dos avaliados, e apenas dois trabalhadores referiam dor no cotovelo antes e três depois do início do trabalho no porto. CONCLUSÃO: A prevalência do diagnóstico sugestivo da síndrome do túnel cubital foi de 6,9%, sendo maior entre os trabalhadores com maior tempo de trabalho (acima de um ano).

Impact of delay in the diagnosis and treatment of head and neck cancer.

INTRODUCTION: Head and neck tumors can be easily recognized through clinical evaluation. However, they are often diagnosed at advanced stages. OBJECTIVE: To evaluate the delay from the patient's initial symptoms to the definitive treatment. METHODS: Retrospective study of patients enrolled in 2011 and 2012. A questionnaire was filled in about socioeconomic aspects, patient history, tumor data, professionals who evaluated the patients, and the respective time delays. RESULTS: The following time delay medians were observed: ten months between symptom onset and the first consultation; four weeks between the latter and the first consultation with a specialist; four weeks between the specialist consultation and diagnosis attainment; and 12 weeks between diagnosis and the start of treatment. CONCLUSIONS: Most head and neck tumors are diagnosed at advanced stages, due to patient and health care factors.

Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review.

BACKGROUND: The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The purpose of this study was to evaluate the impact of PMMF in reducing pharyngocutaneous fistula rates after total laryngectomy. METHODS: The analyzed intervention was the use of a PMMF after total laryngectomy. RESULTS: Pharyngocutaneous fistula occurred in 230 cases (global incidence, 30.9%). In the group of patients who underwent PMMFs, there were 49 cases of pharyngocutaneous fistula, compared with 181 cases in the control group. There was a 22% decreased risk of pharyngocutaneous fistula incidence in the PMMF group (p < .001). Patients who underwent a PMMF had lower risk of pharyngocutaneous fistula compared with the control group (p = .008). There were no changes when only patients who underwent total laryngectomy (p < .001) and those who underwent total pharyngolaryngectomy (p = .007) were separately assessed. CONCLUSION: Prophylactic use of PMMF decreases the incidence of pharyngocutaneous fistula after salvage total laryngectomy. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2317-E2321, 2016.

Preliminary results from minimally invasive video-assisted thyroidectomy.

CONTEXT AND OBJECTIVE: Minimally invasive video-assisted gasless thyroidectomy (MIVAT) has mainly been described in Italy and has been demonstrated to be a safe procedure with additional advantages regarding cosmetic results and postoperative outcome. The aim of this work is to analyze our preliminary results from minimally invasive video-assisted thyroidectomy. DESIGN AND SETTING: Retrospective study at the Head and Neck Surgery Service of Hospital Ana Costa, Santos. METHODS: Twelve patients underwent hemithyroidectomy and another three underwent total thyroidectomy by means of minimally invasive video-assisted thyroidectomy between June and September 2004. Gender, age, goiter volume, major diameter of the dominant nodule, duration of surgery, pain complaints during the first postoperative day, length of hospital stay, cosmetic result and complications were retrospectively analyzed. RESULTS: All the patients were women, with median age of 34. The median goiter volume was 16.5 ml, and the median major diameter of the nodule was 2.3 cm. Ten patients reported mild pain at the surgical site. The median scar size was 2.0 cm and all patients considered the cosmetic results excellent. The median duration of surgery was 55 minutes, all patients were discharged on the first postoperative day, and there were no complications. CONCLUSIONS: The outcome from minimally invasive video-assisted thyroidectomy is good in terms of cosmetic results, analgesia and postoperative recovery. The scar is shorter than in the conventional procedure.

Neck recurrence in papillary thyroid carcinoma / Recidiva cervical no carcinoma papilífero da tireoide

ABSTRACT Introduction: papillary thyroid carcinoma is a tumor with good prognosis. However, some patients treated present neck recurrence. Objective: to evaluate the risk factors for neck recurrence. Methods: a retrospective study enrolled 89 patients (68 women and 21 men) diagnosed with papillary carcinoma who underwent total thyroidectomy. In 21 patients, neck dissection was performed and 62 patients underwent radioiodinetherapy. Twelve patients relapsed with metastasis in this period with an average of 3.6 years. Results: out of 89 patients, 76.4% were female. Relapse occurred in nine (13.23%) women and three (14.28%) men. The average age of the patients was 44 years in the control group and in patients with relapsed. Eighteen patients (23.37%) in the control group and eight (64.28%) who relapsed had positive lymph nodes at initial diagnosis. The tumor size was significantly larger in the group of patients with cervical recurrence (3.3cm vs. 1.6cm - p=0.008, Student t test), whereas the presence of metastatic lymph nodes at the moment of the first operation was also significant (p=0.004 -Fisher exact test). The tumor size was an independent risk factor for recurrence at the multivariate anaylsis (OR=2.4, IC95%:1.3-4.6 - p=0,007, logistic regression). Conclusion: there is an increase in the risk of lymph node recurrence during the follow up of 2.4 folds for each increase of 1cm in the longer nodule diameter.

RESUMO Introdução: o carcinoma papilífero da tireoide é um tumor com bom prognóstico. Entretanto, alguns pacientes tratados evoluem com recidiva cervical. Objetivo: avaliar os fatores de risco para recidiva cervical. Métodos: um estudo retrospectivo arrolou 89 pacientes (68 mulheres e 21 homens) diagnosticados com carcinoma papilífero, submetidos à tireoidectomia total. Em 21 pacientes, realizou esvaziamento cervical e, em 62, radioiodoterapia. Doze pacientes apresentaram recorrência linfonodal no período, com media de 3,6 anos. Resultados: dos 89 pacientes, 76,4% eram mulheres. A falha ocorreu em nove mulheres (13,23%) e três homens (14,28%). A média etária tanto dos pacientes recidivados como do grupo-controle foi de 44 anos. Dezoito pacientes (23,37%) no grupo-controle e oito (64,28%) dentre os que recidivaram tinham linfonodos positivos ao diagnóstico inicial. O tamanho tumoral foi significativamente maior no grupo de pacientes que apresentaram recidiva cervical (3,3 cm vs. 1,6cm - p=0,008, teste t de Student), o mesmo foi observado para a presença de linfonodos metastáticos quando da primeira cirurgia (p=0,004 - teste exato de Fisher). À análise multivariada, o tamanho tumoral foi fator de risco independente de recidiva (OR=2,4, IC95%:1,3-4,6 - p=0,007, regressão logística. Conclusão: para cada aumento de 1cm no maior diâmetro da lesão, há um aumento de 2,4 vezes no risco de recidiva linfonodal ao longo do acompanhamento.

Videolaryngostroboscopy following frontolateral laryngectomy with sternohyoid flap.

We conducted a retrospective study to analyze the videostroboscopic findings in a group of 21 patients who underwent vertical frontolateral laryngectomy with reconstruction by use of the sternohyoid muscle flap. They had T1b and T2 glottic tumors and a follow-up of more than 1 year. Three observers analyzed the recorded videostroboscopic data. The cases in which the stroboscopic evaluation of the vocal folds was incomplete were studied in regard to the clinical staging, the supraglottic hyperfunction, and the vibratory site; the Fisher exact test was applied. The glottic closure was complete in 15 individuals, and 6 had irregular vocal gaps. The site of vibration was glottic in 10 cases, supraglottic in 7, and mixed in 4. The amplitude was normal on 4 and slightly diminished on 9 preserved sides, whereas it was moderately or severely diminished on 16 and absent on 5 reconstructed sides. The mucosal wave vibratory pattern was always totally present on 15 preserved and 5 reconstructed sides: normal or slightly diminished in the preserved vocal folds, and moderately or severely diminished in the reconstructed ones. The reconstructed vocal folds had a nonvibrating portion in 5 cases. The movement extent of the preserved side was larger than that of the other side in 8 cases, and the sides were similar in 13 cases. The symmetry was regular in 18 cases. The periodicity was always or generally regular in 9 cases. There was supraglottic hyperadduction in 16 cases, with a lateral constriction predominance. The mucosal appearance was normal in 15 patients and wet in 6 patients. The epiglottis was straight in 14 cases and crescent in 7. Mucus formation was observed in 1 patient in the posterior vibratory portion. Videolaryngostroboscopy allowed thorough evaluation of the vibratory pattern of the vocal folds in 52.4% of the patients. The supraglottic hyperadduction component and the supraglottic vocal source presented difficulty for this evaluation. The site of vibration was glottic in 47.6%, supraglottic in 33.3%, and mixed in 19.1% of the cases. The vibratory pattern was diminished on both sides, but mainly on the reconstructed one.

Multiple ectopic parathyroid adenomas.

CONTEXT: Primary hyperparathyroidism is the most common cause of hypercalcemia in unselected patients. The ectopic gland locations should be known for appropriate surgical exploration and for avoiding subsequent re-exploration that would represent higher morbidity. Multiple ectopic glands are rare and present a particular challenge in parathyroid surgery. CASE REPORT: A 65-year-old female presented with nephrolithiasis. Her serum total calcium was found to be elevated. The diagnosis of primary hyperparathyroidism was confirmed by the elevated serum intact parathyroid hormone levels. Ultrasound was only successful in localizing one adenoma in the lower right gland. Technetium sestamibi scanning correctly localized the same adenoma and showed another contralateral image, lateral to the thyroid cartilage. Fiber optic laryngoscopy showed an extrinsic mass pushing against the lateral and posterior walls of the left pyriform sinus. Resonance imaging revealed a soft tissue mass. RESULTS: The patient underwent bilateral neck exploration. Histopathological examination confirmed the diagnosis of parathyroid double adenomas. The late-stage postoperative checkups were normal. DISCUSSION: Routine bilateral neck surgery should be performed as a rule. We use ultrasound and technetium sestamibi scanning as a routine for preoperative localization studies. It is helpful to have an experienced surgeon for the localization.

Cervical hibernoma and lipoblastomatosis.

Lipoblastoma and lipoblastomatosis are rare benign soft-tissue tumoral lesions resembling fetal adipose tissue. A total of 16 cases of lipoblastoma of the neck were reported in the literature, and only 3 were described in the posterior side of the neck. Hibernoma is a rare benign adipose tumor composed of brown fat cells and only about ten cases occurring in the cervical area have been reported. We reported two rare cases of adipose tissue tumors. The first case was a male infant aged 12 months who had a cervical mass on the posterior side of the neck. He underwent a complete resection of the lesion and the pathologic study revealed lipoblastomatosis. The second case was a 36-year-old man with an anterior cervical mass, which moved with swallowing. A resection was made and the histological analysis showed hibernoma.

Prevalência da síndrome do túnel cubital em trabalhadores portuários de São Sebastião, São Paulo / Prevalence of cubital tunnel syndrome among dock workers, Saint Sebastian, São Paulo, Brazil

Introdução: Os portos brasileiros têm um papel importante na economia do país. Apesar de haver um número expressivo de trabalhadores, existem poucas pesquisas disponíveis envolvendo o ambiente portuário que relatem que as doenças musculoesqueléticas mais recorrentes correspondem as dos membros superiores, como síndrome do túnel do carpo, síndrome do manguito rotador, cervicalgia e síndrome do túnel cubital, esta definida como uma neurite causada por uma compressão do nervo ulnar no túnel cubital na região do cotovelo. Objetivo: Estimar a prevalência sugestiva da síndrome do túnel cubital no ambiente portuário. Método: Foram avaliados 72 trabalhadores portuários avulsos do OGMO do Porto de São Sebastião, São Paulo, por meio de um questionário semiestruturado, o exame clínico que incluiu a pesquisa de dor à palpação na região medial do cotovelo e a realização de duas manobras específicas para síndrome do túnel cubital, o teste provocativo de pressão e o teste de flexão máxima. Resultados: A idade média foi de 48,49 anos e um tempo médio de 23,13 anos de trabalho no porto; a síndrome do túnel cubital teve diagnóstico sugestivo em cinco dos avaliados, e apenas dois trabalhadores referiam dor no cotovelo antes e três depois do início do trabalho no porto. Conclusão: A prevalência do diagnóstico sugestivo da síndrome do túnel cubital foi de 6,9%, sendo maior entre os trabalhadores com maior tempo de trabalho (acima de um ano)

Background: Ports play a substantial role in the Brazilian economy. Despite the large number of port workers, few studies report that the most common musculoskeletal disorders among them involve the upper limbs, including carpal tunnel syndrome, rotator cuff syndrome, cervicalgia and cubital tunnel syndrome. The latter is a neuritis caused by compression of the ulnar nerve at the cubital tunnel (CuTS) on the elbow. Objective: To estimate the prevalence of a suggestive diagnosis of CuTS among port workers. Method: Seventy-two independent port workers registered with the Labor Management Organ (Órgão Gestor de Mão de Obra ­ OGMO), Port of Saint Sebastian, were evaluated based on a semi-structured questionnaire and clinical examination, including investigation of pain on palpation of the middle area of the elbow and two maneuvers specific for CuTS, namely, the pressure provocation and maximal flexion tests. Results: The average age of the participants was 48.49 years old, and their average length in the job 23.13 years. Suggestive diagnosis of CuTS was established for five participants. In only two cases elbow pain had begun before, and in three after starting work at the port. Conclusion: The prevalence of a suggestive diagnosis of CuTS was 6.9%, and was higher among the participants with longer length in the job (over one year)

Thyroid papillary carcinoma associated to Hashimoto's thyroiditis.

UNLABELLED: There is controversy in the literature regarding the association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) and as to what would be the etiological relationship between them. OBJECTIVE: To establish the proportion of cases among patients with TH and CPT, correlating it with histomorphological aspects. METHOD: A retrospective study of patients undergoing partial or total thyroidectomy for PTC between 2007 and 2009, a total of 41 cases. RESULTS: Regarding the association of HT and CPT, we found 11 cases (26.8%), all females, but without statistical significance. The mean age was 44.9 years among the patients with coexistent TH and CPT, whereas it was 49.1 years without that association. The average size of tumors in those without TH was 20.53 mm and for those with TH it was 12.72 mm (p = 0.4). Regarding pathology staging, the ratios between those with and those without TH were kept in T1a, T1b and T3. In T2, there were no cases of coexistence of HT and PTC. CONCLUSION: There is a rate of 26.8% of patients with association between TH and CPT, but without differences in relation to tumor size.

Risk factors for incidental parathyroidectomy during thyroidectomy.

UNLABELLED: Incidental parathyroidectomy is a common event in thyroid surgery. The literature shows a finding of parathyroid glands ranging from 6.4% to 31% in pathological specimens of the thyroid gland. OBJECTIVE: To collect the amount of parathyroid glands found in surgical specimens of thyroidectomy and correlate with the histopathological and demographic variables. METHODS: Retrospective study based on pathological reports of thyroidectomy from January 2007 to December 2008. RESULTS: 442 patients were submitted to total thyroidectomy, and 2.93% had parathyroid glands, which corresponded to 13 of this total. The presence of papillary thyroid carcinoma associated with incidental parathyroidectomy was 10.11%, compared to the benign lesion: 1.4%. CONCLUSION: Papillary thyroid carcinoma was the variable associated with increased number of incidental parathyroidectomy.

Total thyroidectomy with ultrasonic scalpel: a multicenter, randomized controlled trial.

BACKGROUND: The ultrasonic scalpel is a recently introduced device in head and neck surgery. Total thyroidectomy is the most common endocrine procedure performed by surgeons. METHODS: This was an open, phase IV, multicenter, randomized controlled trial (RCT) that compared the use of an ultrasonic scalpel with a conventional technique in patients who underwent total thyroidectomy. The outcomes were surgical complication rate, operative time, drainage volume, postoperative pain, and costs. RESULTS: In all, 261 patients were included in 11 centers. There was a mean difference of 17% of operative time in favor of the ultrasonic scalpel group. There were no differences in postoperative complications. There was a difference in costs of 14% in favor of the ultrasonic scalpel group, but it was not statistically significant. CONCLUSIONS: The use of an ultrasonic scalpel was as safe as that of the conventional technique and had the advantage of a shorter operative time and lower postoperative drainage. Costs were not different between groups.

[Neck dissection complications]. / Complicações dos esvaziamentos cervicais.

UNLABELLED: Because of the proximity of vital structures, certain complications are inherent to neck dissection (ND) for the treatment of patients with squamous cell carcinoma of the upper aerodigestive tract. AIM: To establish the incidence of complications of ND. METHODS: A cross-sectional retrospective study of patient registries. ND with curative intention was evaluated in 480 patients with squamous cell carcinoma of the upper aerodigestive tract from January 1995 to December 2008 to identify perioperative complications. RESULTS: Considering the total quantity of dissected neck sides, 413 radical ND and 295 selective ND were studied, of which 220 were supraomohyoid ND and 75 were jugular ND, totaling 708 sides. There were no deaths. The most frequent complication was marginal mandibular nerve injury (5.5%), followed by accessory nerve injury (5.1%). However, in 18 out of 21 cases this nerve was sacrificed for oncological completeness. CONCLUSIONS: There were no perioperative deaths. Nerves were the most commonly injured structures; the marginal mandibular branch is injured most (5.5%).

Impact of delay in the diagnosis and treatment of head and neck cancer / Impacto da demora no diagnóstico e tratamento no câncer de cabeça e pescoço

ABSTRACT INTRODUCTION: Head and neck tumors can be easily recognized through clinical evaluation. However, they are often diagnosed at advanced stages. OBJECTIVE: To evaluate the delay from the patient's initial symptoms to the definitive treatment. METHODS: Retrospective study of patients enrolled in 2011 and 2012. A questionnaire was filled in about socioeconomic aspects, patient history, tumor data, professionals who evaluated the patients, and the respective time delays. RESULTS: The following time delay medians were observed: ten months between symptom onset and the first consultation; four weeks between the latter and the first consultation with a specialist; four weeks between the specialist consultation and diagnosis attainment; and 12 weeks between diagnosis and the start of treatment. CONCLUSIONS: Most head and neck tumors are diagnosed at advanced stages, due to patient and health care factors.

RESUMO INTRODUÇÃO: Apesar de poderem ser facilmente reconhecidos ao exame clínico, os tumores de cabeça e pescoço são, muitas vezes, diagnosticados em estadiamento avançado. OBJETIVO: Avaliar a demora entre o surgimento dos sintomas iniciais do paciente e seu encaminhamento para o tratamento definitivo. MÉTODO: Trata-se de um estudo retrospectivo de pacientes arrolados em 2011 e 2012. Foi preenchido questionário sobre fatores sócio-econômicos, antecedentes, dados do tumor, profissionais que avaliaram os pacientes e respectivos períodos de demora. RESULTADOS: Foram observadas as seguintes medianas de tempo de demora: 10 meses entre o início dos sintomas e o primeiro atendimento; 4 semanas entre este e a primeira consulta com o especialista; 4 semanas entre esta e o estabelecimento do diagnóstico; e 12 semanas entre este e o início do tratamento. CONCLUSÕES: A maior parte dos cânceres de cabeça e pescoço é diagnosticada em estádios avançados, por fatores relacionados aos pacientes e à atenção à saúde.

Hibernoma cervical e lipoblastomatose / Cervical hibernoma and lipoblastomatosis

Lipoblastoma e lipoblastomatose são lesões tumorais benignas dos tecidos moles similares ao tecido adiposo fetal. Na literatura, apenas 16 casos de lipoblastoma na região do pescoço foram relatados e, destes, somente 3 foram descritos na região posterior do pescoço. Hibernomas são tumores benignos raros do tecido adiposo composto por células gordurosas marrons. Foram descritos cerca de dez casos desses tumores na região cervical. Este artigo relatou dois casos raros de tumores do tecido adiposo. No primeiro caso, tratou-se de criança do gênero masculino, com 12 meses de idade, com aparecimento de massa cervical na região posterior do pescoço. A ressecção completa da lesão foi realizada, e o estudo patológico revelou lipoblastomatose. O segundo caso ocorreu em um homem de 36 anos com massa cervical anterior, que se movia com a deglutição. Após ressecção à análise histopatológica mostrou hibernoma.

Lipoblastoma and lipoblastomatosis are rare benign soft-tissue tumoral lesions resembling fetal adipose tissue. A total of 16 cases of lipoblastoma of the neck were reported in the literature, and only 3 were described in the posterior side of the neck. Hibernoma is a rare benign adipose tumor composed of brown fat cells and only about ten cases occurring in the cervical area have been reported. We reported two rare cases of adipose tissue tumors. The first case was a male infant aged 12 months who had a cervical mass on the posterior side of the neck. He underwent a complete resection of the lesion and the pathologic study revealed lipoblastomatosis. The second case was a 36-year-old man with an anterior cervical mass, which moved with swallowing. A resection was made and the histological analysis showed hibernoma.

Carcinoma papilífero da tireoide associado à tireoidite de Hashimoto / Thyroid papillary carcinoma associated to Hashimoto's thyroiditis

Existe controvérsia na literatura quanto à associação entre Carcinoma Papilífero de Tireoide (CPT) e Tireoidite de Hashimoto (TH) e também quanto a qual seria a relação etiológica entre ambos. OBJETIVO: Determinar a proporção de casos de TH entre pacientes com CPT, correlacionando com aspectos histomorfológicos. MÉTODO: Foi realizado estudo retrospectivo de pacientes consecutivos submetidos à tireoidectomia parcial ou total por CPT, entre 2007 e 2009, totalizando de 41 casos. RESULTADOS: Em relação à associação de TH e CPT, foram encontrados 11 casos (26,8%), sendo todos do sexo feminino, porém, sem significância estatística. Nos casos em que havia CPT coexistente com TH a idade média foi de 44,9 anos e sem a associação, 49,1 anos. O tamanho médio dos tumores entre os sem TH foi 20,53mm e os com TH foi de 12,72 mm - p = 0,4. Em relação ao estadiamento anatomopatológico, as proporções entre os que apresentam TH e os que não apresentam foram mantidas em T1a, T1b e T3. Em T2, não houve casos de coexistência entre TH e CPT. CONCLUSÃO: Há uma proporção de 26,8% de pacientes que possuem associação entre TH e CPT, porém, sem diferenças em relação ao tamanho do tumor.

There is controversy in the literature regarding the association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) and as to what would be the etiological relationship between them. OBJECTIVE: To establish the proportion of cases among patients with TH and CPT, correlating it with histomorphological aspects. METHOD: A retrospective study of patients undergoing partial or total thyroidectomy for PTC between 2007 and 2009, a total of 41 cases. RESULTS: Regarding the association of HT and CPT, we found 11 cases (26.8%), all females, but without statistical significance. The mean age was 44.9 years among the patients with coexistent TH and CPT, whereas it was 49.1 years without that association. The average size of tumors in those without TH was 20.53 mm and for those with TH it was 12.72 mm (p = 0.4). Regarding pathology staging, the ratiosbetween those with and those without TH were kept in T1a, T1b and T3. In T2, there were no cases of coexistence of HT and PTC. CONCLUSION: There is a rate of 26.8% of patients with association between TH and CPT, but without differences in relation to tumor size.