[Association of three anatomical variants of the anterior cerebral circulation]. / Asociación de tres variantes anatómicas de circulación cerebral anterior.

BACKGROUND: As part of a study of the microsurgical anatomy of the pericallosal artery, we describe one brain with three unusual anatomical variants. METHODS: From the autopsy of a 45 year-old female, we extracted the brain and all the arterial blood vessels were washed off with saline solution to be injected afterwards with red latex. The brain was then immersed in 10% formalin for two months. Finally, we dissected and measured the internal carotid artery segments, using a digital Vernier caliper under a Carl Zeiss OPMI surgical microscope with magnification of 6x up to 40x. RESULTS: The brain's weight was 1250 grams and three rare anatomical variants were found: 1) right accessory middle cerebral artery (ACMA-d), 2) right bihemispheric anterior cerebral artery (ACABihem-d), 3) median artery of the corpus callosum (AMCC). CONCLUSION: The association of the anatomical variations described previously is inconstant; furthermore, their appearance in a single case is rare.

[Hypothyroidism incidence after multimodal treatment for laryngeal cancer]. / Incidencia de hipotiroidismo secundario a tratamiento multimodal en cáncer de laringe.

BACKGROUND: Hypothyroidism following total laryngectomy or radiotherapy treatment for laryngeal cancer is not a rare event, especially in advanced stages. There are no reports on the incidence of hypothyroidism in patients who received chemotherapy and radiotherapy. The objective of this study is to determine the incidence of thyroid dysfunction in a group of patients with laryngeal cancer who underwent surgery as sole treatment, total laryngectomy or radiotherapy alone, and patients with combined treatment: surgery plus radiotherapy, concomitant chemoradiation therapy and chemoradiation therapy plus salvage surgery. METHODS: A prospective study of patients diagnosed with laryngeal cancer whose serum TSH and T4 levels were evaluated in a serial fashion. RESULTS: 70 patients with laryngeal cancer were studied; the average age at diagnosis was 70.2 years. Male patients were more affected, with a men-women ratio of 3.6:1. Glottic localization was the most frequent (44%). 64% of tumors were locally advanced carcinomas and 51% received multimodal treatment. 45 patients (63%) were diagnosed with hypothyroidism; 49% of the patients with subclinical hypothyroidism, and 51% with clinical hypothyroidism. CONCLUSIONS: Hypothyroidism is a complication following treatment for laryngeal cancer. It is recommended to evaluate the thyroid function periodically for timely detection.

Extraosseous osteosarcoma in the neck.

BACKGROUND: Extraosseous osteosarcoma arising in the head and neck region is an exceptional finding, with a few isolated cases informed in the literature. We report a new case of a large high-grade extraosseous osteosarcoma located in the neck. CASE PRESENTATION: A 74 year-old woman with a tumor on the right side of the neck was treated by complete surgical resection. The histopathological diagnosis was osteoblastic extraosseous osteosarcoma. PET-CT scan disclosed no evidence of disease in other areas. Patient received adjuvant radiotherapy and after 3 months of follow-up tumor activity was detected in the cavernous sinus and the patient died of disease one month later. CONCLUSION: Extraosseous osteosarcoma in head and neck region is exceptional, and incisional biopsy is the only method to establish a diagnosis and the one to differentiate it from other bone-producing soft tissue tumors. Surgery is the gold standard for treatment of extraosseous osteosarcoma.

Resección arterial de grandes vasos debido a tumor germinal residual retroperitoneal: Tres casos / Arterial resection of large vessels due to a residual germinal retroperitoneal tumor: Three cases

Objetivo: Demostrar la factibilidad, morbilidad y beneficio terapéutico de la resección de tumor residual en los grandes vasos. Sede: Instituto Nacional de Cancerología México. Diseño: Reporte de casos Métodos: Se revisaron expedientes de 2004 al 2008, encontrando 58 pacientes susceptibles de linfadenectomía retroperitoneal posterior a tratamiento con quimioterapia por tumores germinales no seminomatosos. Tres pacientes fueron candidatos a resección y reconstrucción de grandes vasos mediante una prótesis de politetrafluoretileno (PTFE). Resultados: La edad media fue de 28.5 años al momento del diagnóstico. La media del tumor fue de 5.75 cm. El sangrado promedio transoperatorio fue de 500 ml. El seguimiento fue de 27 meses posterior al remplazo vascular. Un paciente murió a los 3 días de postoperatorio por insuficiencia renal. Conclusión: El remplazo aórtico en tumores residuales retroperitoneales posterior a quimioterapia, debe ser realizado en casos seleccionados con el fin de obtener un beneficio real en supervivencia, siendo factible de realizar con poca morbimortalidad en centros especializados.

Objective: To demonstrate the feasibility, morbidity, and therapeutic benefit of the resection of large vessels' residual tumor. Setting: National Institute of Cancerology, Mexico. Design: Case report. Methods: We reviewed case histories from 2004 to 2008 during which 58 patients were susceptible to retroperitoneal lymphadenectomy after treatment with chemotherapy due to germinal non-seminomatous tumors. Three patients were candidates for resection and reconstruction of large vessels by means of a polytetrafluorethylene (PTFE) prosthesis. Results: Mean age was of 28.5 years at the time of diagnosis. The mean average size of the tumor was of 5.75 cm. Average transoperative bleeding amounted to 500 ml. Follow-up was of 27 months after the vascular replacement. One patient died 3 days after surgery due to renal failure. Conclusion: Aortic replacement in retroperitoneal tumors after chemotherapy should be performed in selected cases to obtain an actual benefit in survival, and it is possible to perform with low morbidity and mortality in specialized medical centers.

Hybrid salivary gland tumor of the upper lip or just an adenoid cystic carcinoma? Case report.

UNLABELLED: A 65 year-old male patient with a one year-duration tumoral growth located in the upper lip was diagnosed on incisional biopsy as epithelial-myoepithelial carcinoma. After wide surgical excision the histopathological analysis revealed the lesion was composed predominantly (>90%) of adenoid cystic carcinoma. In new sections it was found a very small and isolated area of adenoid cystic carcinoma at the bottom of the incisional biopsy. As surgical margins were free of lesion, no adjuvant treatment was given. The occurrence of a transitory ischaemic attack at 36 months of follow-up led to a neurological and MRI evaluation, which disclosed a well-defined 3.5 x 3 cm lesion suggestive of metastasis, located on the right temporal area. The lesion was surgically removed and a histopathological diagnosis of neurocysticercosis was rendered. After 40 months of follow-up there is no evidence of recurrence. CONCLUSION: True hybrid tumors of salivary glands are rare and treatment in each case should be done according to the component with the higher aggressiveness. However, the occurrence of epithelial-myoepithelial carcinoma areas within an adenoid cystic carcinoma seems to be a frequent finding, and because both lesions share a common origin, some authors consider that this may not be a true hybrid neoplasm but a variant of the latter.

Giant retroperitoneal liposarcoma.

BACKGROUND: Liposarcoma is the most frequent histopathological variety of the retroperitoneum, surgery is the gold standard for treatment. CASE PRESENTATION: We present the case of a 24-year-old male who was diagnosed with a giant retroperitoneal liposarcoma. The patient received palliative treatment due to non-resectability on the basis of chemotherapy. We decided to perform surgery after no benefit was received with systemic treatment. Complete macroscopic resection of the tumor was performed, without multi-organ resection. The patient is currently alive and disease free at 14 months of evolution. CONCLUSION: Retroperitoneal liposarcomas represent a unique situation and require a more aggressive surgical approach including multiple resections for recurrences. Based on the ability of the patient to tolerate the procedure, surgery is suggested to evaluate resectability of the tumor. We must take into consideration whether prolonged survival will be attained and tumor removal will result in palliation of symptoms.