Cutaneous angiosarcoma of the head and neck: report of 23 cases from a single institution.

BACKGROUND: To report a single-institution experience in the treatment of cutaneous head and neck angiosarcoma. STUDY DESIGN: Case series. PATIENTS AND METHODS: Twenty-three patients were evaluated: 12 females and 11 males. The primary site of the lesion was the neck in 9 patients, the scalp in 9, and the face in 5. No patient had been submitted to previous treatment but 10 were submitted to incisional biopsy. The lesions' size ranged from 2.5 to 12 cm (median 4 cm). RESULTS: All but one patient were submitted to surgical resection as primary treatment. Twenty-two patients received adjuvant treatment: 8 cases of local recurrence and 12 cases of distant metastasis. Two patients presented synchronous local and distant relapses. The 5-year survival rate was 21.7 percent. In our series, the only factor affecting survival was histological grade (odds ratio = 6.7; 95% confidence interval, 1.6-28.9). CONCLUSION: Our results for 5-year survival are comparable to those in the literature with a treatment based on complete surgical resection. The only significant prognostic factor was tumor histological grade.

Auricular rehabilitation by means of bone grafting from the iliac crest in combination with porous extraoral implants: a case report.

BACKGROUND: Maxillofacial defects caused by cancer treatment are a huge problem affecting the quality of life of patients. Some of these deformities are minimized using facial epitheses, which need some additional retention devices like glasses or skin adhesives. The use of extraoral fixtures as bone anchorage was introduced many years ago and since then many patients were rehabilitated with better results. PURPOSE: Because of poor bone conditions, for example, irradiated bone, the success rate of extraoral implants is less than in the oral cavity, causing difficulties to rehabilitation. One possible cause of fixture failure could be the poor primary stability achieved in some cases, hence, with an increased bone contact implant stability and survival could be improved. The present report discusses possibilities to use extraoral fixtures with a modified surface structure. MATERIALS AND METHODS: A new porous surfaced Brazilian extraoral implant (MasterExtra, Conexão, Sistema de Próteses, São Paulo, Brazil) was used. A bone transplant from the iliac crest was taken to make it possible to insert at least three extraoral implants for an auricle epithesis. Clinical evaluation and resonance frequency analysis (RFA) measurements were performed during the course of the treatment. RESULTS: Eight months after grafting, four fixtures were inserted. Three fixtures were used for connection of an auricular epithesis. RFA measurements did show high initial values and the values remained stable during the course of the treatment and at later checkups. CONCLUSION: Porous fixture is a good option in areas where the bone is compromised. RFA is a good tool also in the clinical setting to evaluate immediate and long-term stability of extraoral fixtures.

Vulvar melanoma: report on eleven cases and review of the literature.

CONTEXT AND OBJECTIVE: Vulvar melanoma is a rare disease. We describe the experience of a single institution and review the literature. DESIGN AND SETTING: Retrospective study at the Department of Gynecology, Hospital do Cancer A. C. Camargo. METHODS: Eleven patients with vulvar melanoma attended between January 1987 and December 2006 were reviewed regarding clinicopathological characteristics, surgical therapy and follow-up. RESULTS: The initial symptoms were vulvar lesions, pruritus, pain and bleeding. The median age was 64.8 years. The median depth of invasion was 3.08 mm. The staging ranged from IB to IIIC (American Joint Committee on Cancer, 2002). All the patients underwent vulvectomy. Two patients did not undergo primary elective lymphadenectomy. Bilateral inguinal lymphadenectomy was performed on five patients, and one had unilateral inguinal lymphadenectomy. Sentinel lymph node investigation was performed on three patients. Five patients had locoregional recurrence. Prolonged survival was only achieved in the absence of lymph node involvement. The median follow-up was 56 months. The median disease-free survival was 15 months and the median overall survival was 29 months. CONCLUSIONS: The prognosis for patients with vulvar melanoma is generally poor, with a high tendency towards regional and distant recurrence. Depth of invasion and lymph node involvement are the most important prognostic factors. In most cases, resection of the lesion with adequate margins may replace vulvectomy. Elective inguinal femoral lymphadenectomy remains the standard lymph node staging procedure. Sentinel lymph node investigation is feasible and should be performed by a multidisciplinary team with experience of this method.

Proteins involved in pRb and p53 pathways are differentially expressed in thin and thick superficial spreading melanomas.

Cutaneous melanoma is one of the leading causes of cancer-related death. Malignant transformation of epidermal melanocytes is a multifactorial process involving cell cycle and death control pathways. The purpose of this study was to analyze the immunohistochemical expression of cell-cycle-related and apoptosis-related proteins in cutaneous superficial spreading melanomas using the tissue microarray technique to further understand tumor development. A total of 20 samples of in-situ melanomas and 44 melanomas 1.0 mm) and metastases lost p16 expression in 100% of the cases and in-situ and thin melanomas (

Structural correlations between dermoscopic features of cutaneous melanomas and histopathology using transverse sections.

Interpretation of dermoscopic features of cutaneous melanoma is based on histologic description of perpendicular sections of the lesions that does not reflect the overview achieved by epiluminescence. We describe the utilization of transverse sections as a tool to define the histopathology of features that are the dermoscopic hallmarks of cutaneous melanoma. From a collection of 23 pigmented lesions with the dermoscopic diagnosis of cutaneous melanoma submitted for surgical excision we selected, from each specimen, one dermoscopic feature (black dots and globules, brown dots, blues dots and globules, depigmentation, broadened network, radial streams or pseudopods) that was sampled with a 4-mm punch (specimen) to obtain perpendicular and transverse sections. Using this strategy, it was possible to correlate the histopathology of all features that are often used as criteria for diagnostic dermoscopy. The black dots were pigmented neoplastic cells at the dermal-epidermal junction (DEJ) and within the epidermis in heavily pigmented columns. Similar findings were seen in brown dots, however there was slightly less pigment. No statistical difference was observed between brown dots and black dots regarding size, area and number of atypical cellnests. Blue dots correlated to melanophages, surrounding the superficial vascular plexus. Depigmentation was characterized by intense fibrosis of the papillary dermis. The pigmented network showed atypical pigmented or non-pigmented melanocytes at the DEJ and epidermis as well as heavily pigmented keratinocytes in the basal cell layer. The radial streaming and pseudopods had neoplastic cells in nests, a stratified growth pattern arranged in centrifugal linear extensions, resembling a arborescent branching. The results represented herein, are an important tool for understanding histopathological alterations responsible for dermoscopic features and for improving the efficacy of this diagnostic method.

Vulvar melanoma: report on eleven cases and review of the literature / Melanoma de vulva: relato de onze casos e revisão da literatura

CONTEXT AND OBJECTIVE: Vulvar melanoma is a rare disease. We describe the experience of a single institution and review the literature. DESIGN AND SETTING: Retrospective study at the Department of Gynecology, Hospital do Cancer A. C. Camargo. METHODS: Eleven patients with vulvar melanoma attended between January 1987 and December 2006 were reviewed regarding clinicopathological characteristics, surgical therapy and follow-up. RESULTS: The initial symptoms were vulvar lesions, pruritus, pain and bleeding. The median age was 64.8 years. The median depth of invasion was 3.08 mm. The staging ranged from IB to IIIC (American Joint Committee on Cancer, 2002). All the patients underwent vulvectomy. Two patients did not undergo primary elective lymphadenectomy. Bilateral inguinal lymphadenectomy was performed on five patients, and one had unilateral inguinal lymphadenectomy. Sentinel lymph node investigation was performed on three patients. Five patients had locoregional recurrence. Prolonged survival was only achieved in the absence of lymph node involvement. The median follow-up was 56 months. The median disease-free survival was 15 months and the median overall survival was 29 months. CONCLUSIONS: The prognosis for patients with vulvar melanoma is generally poor, with a high tendency towards regional and distant recurrence. Depth of invasion and lymph node involvement are the most important prognostic factors. In most cases, resection of the lesion with adequate margins may replace vulvectomy. Elective inguinal femoral lymphadenectomy remains the standard lymph node staging procedure. Sentinel lymph node investigation is feasible and should be performed by a multidisciplinary team with experience of this method.

CONTEXTO E OBJETIVO: Melanoma de vulva é uma doença rara. Descrevemos a experiência de uma instituição e revisamos a literatura. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo no Departamento de Ginecologia do Hospital do Câncer A. C. Camargo. MÉTODOS: De Janeiro de 1987 a Dezembro de 2006, foram revisados aspectos clínico-patológicos, tratamento cirúrgico e acompanhamento de 11 pacientes com melanoma de vulva. RESULTADOS: Lesão vulvar, prurido, dor e sangramento foram sintomas iniciais. A idade mediana foi 64,8 anos. A mediana da profundidade de invasão foi 3.08 mm. O estadiamento variou de IB a IIIC (American Joint Committee on Cancer, 2002). Todas as pacientes foram submetidas a vulvectomia. Duas pacientes não foram submetidas a linfadenectomia eletiva primária. A linfadenectomia inguinal bilateral foi realizada em cinco pacientes e uma foi submetida à linfadenectomia inguinal unilateral. A pesquisa do linfonodo sentinela foi realizada em três casos. Cinco tiveram recidiva locorregional. A sobrevida prolongada esteve relacionada com a ausência de comprometimento linfonodal. O tempo mediano de acompanhamento foi de 56 meses. A sobrevida mediana livre de doença foi de 15 meses e a sobrevida mediana global de 29 meses. CONCLUSÕES: O prognóstico das pacientes com melanoma de vulva geralmente é ruim, com tendência a recorrência regional e à distância. A profundidade de invasão e envolvimento linfonodal são os principais fatores prognósticos. Na maioria dos casos a ressecção da lesão com margens adequadas pode substituir a vulvectomia. A linfadenectomia inguino-femoral eletiva ainda é o procedimento padrão para estadiamento linfonodal. Pesquisa do linfonodo sentinela é factível e deve ser realizada por equipe multidisciplinar com experiência no método.

Dermatoscopia: o método de análise de padrões / Dermoscopy: the pattern analysis

A incidência do melanoma cutâneo tem aumentado mundialmente e, por tratar-se de neoplasia bastante agressiva e de difícil tratamento em estádios mais avançados, o diagnóstico precoce é fundamental para a cura do paciente. A dermatoscopia surgiu como exame auxiliar in vivo, que tem papel fundamental na realização do diagnóstico precoce e amplifica a acurácia diagnóstica do melanoma. Para a realização do método, é necessário utilizar o dermatoscópio, aparato que permite aumentar a lesão, no mínimo, 10 vezes. A imagem obtida é interpretada utilizando-se o método diagnóstico da preferência do examinador. O método de Análise de Padrões é atualmente o mais utilizado e o que possui maior acurácia para o diagnóstico do melanoma cutâneo, tendo-se demonstrado confiável para o ensino de residentes em dermatologia. Baseia-se em padrões globais e específicos que permitem diferenciar as lesões melanocíticas das não melanocíticas (também importantes no diagnóstico diferencial com o melanoma cutâneo), assim como identificar lesões melanocíticas consideradas benignas, suspeitas ou malignas.

Traumatismos extensos do pavilhäo auricular: conduta cirúrgica / Extensive traumatisms of the external ear: surgical management

Cinqüenta e nove pacientes com traumatismos extensos do pavilhäo auricular, sendo três com amputaçäo total, 10 com amputaçäo parcial com manutençäo de pedículo reduzido e 46 com lesöes extensas, porém com vascularizaçäo preservada, atendidos no período de 1979 a 1989. Säo descritas e discutidas detalhadamente as condutas cirúrgicas usadas para cada caso

Abdominoplastia em ancora para o tratamento das deformidades abdominais secundárias / Abdominoplasty in anchor for the treatment of secondary abdominal deformities

O cirurgiao geral gracas ao aprimoramento tecnico e cientifico, pratica intervencoes sucessivas no abdome para o tratamento de diversas afeccoes. Como consequencia, podem resultar, ou nao, defeitos na parade abdominal como herniacoes, eventracoes, cicatrizes deformantes e modificacoes inesteticas do contorno corporal. No presente trabalho, os autores trataram de 10 pacientes que foram assistidos por cirurgioes gerais, em decorrencia de diversas patologias, tendo a sobrevida garantida; todavia, ficaram portadores de sequelas que constituiram desafio e, para enfrenta-lo, os autores propoem a tecnica de Correa-Iturraspe, consagrada como abdominoplastia em ancora, que foi prescrita preliminarmente para tratamento cirurgico da obesidade. Esta tecnica resulta em uma cicatriz que, se por um lado tem aspectos criticos quanto a qualidade, por outro e atraves dela que se conseguiu corrigir as deformidades da parede e atenuar os aspectos desarmonicos do controno corporal, resultantes das cirurgias preliminares. Assim, embora a abdominoplastia proposta na sua forma classica, por Correa-Iturraspe, resulte em cicatrizes aquem do desejavel, ela nao deve ser relegada, pois permite modificacoes que redundam em bons resultados esteticos e funcionais, ainda que avaliados subjetivamente. ora pelo paciente, ora pelo cirurgiao plastico

Utilizaçäo do músculo grácil na reconstruçäo do períneo / Use of gracilis muscle in the reconstruction of perineum

Os autores estudaram dez pacientes submetidos a reconstruçäo da vulva e regiäo perineal com retalhos miocutâneos do músculo grácil. Utilizaram retalhos miocutâneos em sete perdas resultantes de ressecçäo de tumor, dois de trauma e em um conseqüente a processo infeccioso (síndrome de Fournier). As reconstruçöes pós-tumorais foram realizadas de imediato, enquanto as pós-traumáticas, secundariamente. Todos os retalhos mediam 12x8cm e o músculo foi utilizado em sua totalidade. Todos os pacientes evoluíram satisfatoriamente, preenchendo os objetivos delineados. Houve necroses parciais em oito casos. Em três desse, observou-se necrose parcial da porçäo cutânea do retalho, que necessitou de enxertia de pele secundariamente. Os autores puderam concluir que a ilha de pele associada ao retalho muscular pode trazer alguns riscos de complicaçöes e que revisöes secundárias podem ser necessárias. Sugerem que, em casos específicos poder-se ia utilizar somente o músculo associado a enxertia de pele

Sindrome do choque toxico apos mamoplastia redutora: relato de caso / Toxic shock syndrome after reduction mammoplasty: report of a case

As caracteristicas clinicas da sindrome do choque toxico (SCT) sao bem conhecidas e acredita-se que estao relacionadas a presenca de exotoxinas liberadas por infeccoes estafilococicas. Sao quadros graves, de desenvolvimento rapido e que podem ser fatais se nao reconhecidos e tratados prontamente. Os primeiros casos foram descritos em mulheres fazendo uso de tampao vaginal e que apresentavam culturas de secrecoes vaginais positivas para Staphylococcus aureus. Mais recentemente tem sido descritos casos relacionados a varios tipos de infeccoes estafilococicas, pos-operatorias ou nao. Apresentamos o relato de um caso, bastante grave, de SCT apos mamoplastia redutora numa doente de 18 anos de idade; e de grande importancia o conhecimento desta entidade clinica para que seja feito o diagnostico precoce e a instituicao do tratamento adequado.