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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.
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BACKGROUND: To explore the efficacy and patterns of treatment failure of radical radiotherapy in newly diagnosed oligo-metastatic nasopharyngeal carcinoma patients. METHODS: We included 39 newly diagnosed oligo-metastatic nasopharyngeal carcinoma patients who received radical radiotherapy and chemotherapy in Zhejiang Cancer Hospital. Treatment and prognosis information were collected. The Kaplan-Meier methods and Cox proportional hazards models were used to calculate survival rates and analyze prognostic factors. RESULTS: After a median follow-up time of 38 months, the 1-, 3-, and 5-year overall survival rates were 97, 70, and 57.9%, while the 1-, 3-, and 5-year progression-free survival rates were 87, 59, and 50.9%, respectively. Age, numbers of metastases lesions, cycles, and schemes of chemotherapy were independent prognostic factors of the overall survival. Patients with no more than three metastasis lesions had a higher survival rate than those with ≥ 3 metastatic lesions (P = 0.023). More than four cycles chemotherapy provide a higher survival rate than less than four cycles. Chemotherapy including docetaxel had a significantly survival advantages (P = 0.041). CONCLUSION: Radical radiotherapy is important for newly diagnosed oligo-metastatic nasopharyngeal carcinoma patients, which can still achieve long-term survival after chemo-radiotherapy.
Subject(s)
Chemoradiotherapy/methods , Nasopharyngeal Carcinoma/radiotherapy , Nasopharyngeal Neoplasms/radiotherapy , Adolescent , Adult , Aged , Chemoradiotherapy/mortality , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Nasopharyngeal Carcinoma/drug therapy , Nasopharyngeal Carcinoma/mortality , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/mortality , Neoplasm Metastasis/drug therapy , Neoplasm Metastasis/radiotherapy , Prognosis , Proportional Hazards Models , Retrospective Studies , Young AdultABSTRACT
Objetivo: Exponer nuestra experiencia y evaluar la recurrencia en el manejo quirúrgico del angiofibroma nasal juvenil, abordaje abierto contra endoscópico, en el servicio de otorrinolaringología del noroeste del país. Materiales y métodos: Estudio observacional, retrospectivo, analítico. Se revisaron los expedientes clínicos de los pacientes con diagnóstico de angiofibroma nasal juvenil de 2014 a 2017, atendidos en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello de esta institución. Resultados: Un total de 19 pacientes con diagnóstico de angiofibroma nasal juvenil, fueron sometidos a un procedimiento quirúrgico, 14 abiertos y 5 endoscópicos, la recurrencia fue de 50 % y 40 % respectivamente, lo cual no fue estadísticamente significativo (p=0.88). No obstante, se contrastaron otras variables, como la necesidad de la Unidad de Cuidados Intensivos (UCI) para ambos grupos, 71 % en abordaje abierto y 20 % para el endoscópico, en lo cual si encontramos diferencia significativa (p=0.04). Conclusiones: El estudio no muestra una ventaja estadísticamente significativa del abordaje endoscópico frente al abordaje abierto, pero sí una menor necesidad de hospitalización en UCI, lo que reduciría los costos de atención.
Objective: To present our experience and assess the recurrence of juvenile nasopharyngeal angiofibroma after a surgical treatment (open versus endoscopic approach) in the country's northwestern Department of Otorhinolaryngology. Materials and methods: An observational, retrospective, analytical study. The medical records of patients diagnosed with juvenile nasopharyngeal angiofibroma, who were treated at the Department of Otorhinolaryngology - Head and Neck Surgery of this institution from 2014 to 2017, were reviewed. Results: A total of 19 patients diagnosed with juvenile nasopharyngeal angiofibroma underwent a surgical procedure, out of which 14 had an open surgery and 5 an endoscopic one. Recurrence accounted for 50 % and 40 %, respectively, which was not statistically significant (p = 0.88). However, other variables were compared, such as the need for admission to the Intensive Care Unit (ICU), which was represented by 71 % in the case of the open approach and 20 % for the endoscopic approach, where a significant difference was found (p = 0.04). Conclusions: The study shows no statistically significant advantage of the endoscopic approach versus the open approach, but demonstrates less need for ICU admissions, which would reduce healthcare costs.
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Introdução: O nasoangiofibroma juvenil (NAJ) é um tumor benigno, raro, cujo diagnóstico é baseado na tríade de epistaxe, obstrução nasal e presença de tumor na nasofaringe, associado a exames de imagem. O tratamento de escolha é a ressecção cirúrgica, podendo ser realizada por via aberta e/ou endoscópica. Objetivo: Apresentar série de casos de pacientes submetidos a tratamento cirúrgico por via endoscópica. Método: Estudo retrospectivo com revisão em prontuários de três pacientes submetidos à ressecção de NAJ por via endoscópica exclusiva. Resultados: Os três pacientes eram do sexo masculino com idades de 13, 25 e 31 anos. Foi realizada remoção completa do tumor em todos os casos. Um paciente evoluiu com lesão parcial de nervo óptico. Conclusão: A ressecção de NAJ por via endoscópica é possível, inclusive em casos com invasão intracraniana. Entretanto um profundo conhecimento da anatomia, além de instrumental específico é fundamental para a realização de cirurgias seguras e efetivas.
Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a benign and rare tumor. Diagnosis is based on the triad of epistaxis, unilateral nasal obstruction and presence of nasopharyngeal tumor associated with imaging studies. The treatment of choice is the surgical resection. It can be performed by open method and/or endoscopically. Objective: To present a case series of endoscopic surgical treatment of JNA. Method: A retrospective study reviewing the medical records of three patients who underwent exclusively endoscopic resection of JNA. Results: The three patients were males aged 13, 25 and 31 years. A complete resection was performed in all cases. One patient had a partial lesion of the optic nerve. Conclusion: The exclusively endoscopic resection of JNA is possible, even in cases with intracranial invasion. However, a solid knowledge of anatomy and specific instruments are essential to achieve safe and effective surgery.
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Introdução: O condrossarcoma é uma neoplasia maligna do tecido cartilaginoso que representa 20 a 25% de todos os sarcomas ósseos, sendo que apenas 10 a 12% estão situados na região de cabeça e pescoço. Objetivo: Este artigo tem como objetivo relatar um caso raro de condrossarcoma de nasofaringe apresentando boa evolução. Relato de Caso: MLCV, feminino, 70 anos, com dor facial à esquerda e perda de visão de olho esquerdo de início há 3 meses. Anosmia e obstrução nasal esquerda também presentes. Ressonância magnética mostrou lesão expansiva em nasofaringe, com 4cm em seu maior diâmetro, com extensão para seios etmoidais, região posterior das fossas nasais, septo nasal, seio esfenoidal e extensa infiltração do clivus. Biópsia mostrou condrossarcoma GII. Paciente foi submetida à ressecção de tumor da base do crânio via degloving apresentando boa evolução e sendo em seguida submetida à radioterapia. Atualmente segue em acompanhamento há 5 anos, sem sinais de recidiva. Conclusão: O caso em questão ilustra uma localização pouco usual de condrossarcoma cujo tratamento e curabilidade são bastante complexos em função da localização e da exigüidade de margens cirúrgicas. Apesar das dificuldades inerentes a estes aspectos, graças a inclusão do condrossarcoma na gama dos diagnósticos diferenciais e à combinação entre o tratamento cirúrgico e a radioterapia, foi possível obter o controle da doença a longo prazo com menor morbidade ao paciente.
Background: Chondrosarcoma is a malignant tumor of cartilaginous tissue that represents 20-25% of all bone sarcomas. Only 10 to 12% are located in the head and neck. Aim: The aim of this study is to report a rare nasopharynx chondrosarcoma case with positive outcome. Case Report: MLCV, female, 70 years old, complaining about left facial pain and loss of vision in left eye which started 3 months ago. Olfatory loss and left nasal obstruction were also present. MRI showed nasopharynx lesion, with 4cm in its largest diameter, extending to the ethmoid sinus, posterior region of nasal cavity, nasal septum, sphenoid sinus and extensive infiltration of clivus. Biopsy revealed chondrosarcoma GII. The patient underwent tumor resection via degloving presenting good evolution and was then submitted to radiotherapy. The follow up is now 5 years and the patient has no signs of recurrence. Conclusion: This case reports an unusual chondrosarcoma location in which treatment and curability are quite complex depending on the location and the exiguity of surgical margins. Despite the difficulties inherent to these aspects, thanks to the inclusion of chondrosarcoma in the range of differential diagnoses and to the combination of surgery and radiotherapy, it was possible to control the disease in long term with less morbidity to the patient.
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The dermoid is a rare and benign malformation of bigerminal origin. It is seen frequently in the neonatal period, and the clinical presentation depends on the site and on the size of the lesion, and the classical clinical picture is of a tumor derived from the naso- or oropharynx, leading to respiratory distress and/or feeding disorders. A female newborn was born cyanotic requiring intubation. The oroscopy revealed a large smooth mass. Transoral surgery was performed with successful extubation. Seven months after, there are no signs of recurrence of the lesion. This report adds another case of this rare pathology that can be life-threatening condition in the neonate. It emphasizes the importance of dermoid in the differential diagnosis of the naso- or oropharyngeal lesions, especially in neonates.
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The dermoid is a rare and benign malformation of bigerminal origin. It is seen frequently in the neonatal period, and the clinical presentation depends on the site and on the size of the lesion, and the classical clinical picture is of a tumor derived from the naso- or oropharynx, leading to respiratory distress and/or feeding disorders. A female newborn was born cyanotic requiring intubation. The oroscopy revealed a large smooth mass. Transoral surgery was performed with successful extubation. Seven months after, there are no signs of recurrence of the lesion. This report adds another case of this rare pathology that can be life-threatening condition in the neonate. It emphasizes the importance of dermoid in the differential diagnosis of the naso- or oropharyngeal lesions, especially in neonates...
Subject(s)
Humans , Female , Infant, Newborn , Dermoid Cyst , Nasopharyngeal Neoplasms , Respiratory Distress Syndrome, Newborn , Magnetic Resonance ImagingABSTRACT
Malignant neoplasms of the nasopharynx are very rare and has two peaks of incidence: below the age of 30, and between the 4th and 5th decade of life. It is, however, uncommon after the 60 years of age. In rare cases, some patients may present, in the form of paraneoplastic syndrome, hypertrophic osteoarthropathy (HOA). In this case report, we describe a case of HOA from lymphoepithelioma of the nasopharynx in a 77-year-old male patient, representing an extremely unusual condition.
Neoplasias malignas de nasofaringe são muito raras e apresentam dois picos de incidência: antes dos 30 anos e entre a 4ª e 5ª década de vida. No entanto, é incomum após os 60 anos de idade. Em raros casos, alguns pacientes apresentam na forma de síndrome paraneoplásica a Osteoartropia Hipertrófica (OAH). Este relato de caso, nós descrevemos um caso de OAH associada a linfoepitelioma de nasofaringe em um paciente de 77 anos, representando um condição extremamente incomum.
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Humans , Male , Aged , Nasopharyngeal Neoplasms , Osteoarthropathy, Secondary HypertrophicABSTRACT
PURPOSE: Dental aesthetics has considerable impact in our beauty-conscious society. The darkening of the anterior teeth causes concern for adolescents due to the compromised physical appearance. This article presents a clinical case of tooth staining in an individual who had undergone radiotherapy/chemotherapy for an undifferentiated nasopharyngeal carcinoma. CASE DESCRIPTION: A 14-year-old boy presented to the dental clinic complaining of pain and staining of the maxillary and mandibular incisors, canines and premolars after having undergone radiotherapy/chemotherapy and stated his desire to remove the dark stains from the surface of the teeth due to his compromised oral aesthetics. Tooth whitening was performed with hydrogen peroxide, followed by micro-abrasion. At a two-year follow-up visit, clinical success was observed and the child was very satisfied. CONCLUSION: The adoption of such methods provided efficient alternatives for the re-establishment of a healthy smile, thereby returning pleasing facial aesthetics to the patient. The minimization of distress is nearly always the focus of clinical efforts at promoting psychological health in cancer survivors.
OBJETIVO: Atualmente, a estética dentária tem um impacto considerável na sociedade. O escurecimento dos dentes anteriores causa preocupação para os adolescentes, devido à aparência física comprometida. Este artigo apresenta um caso clínico de descoloração dentária em um indivíduo submetido a radioterapia/quimioterapia para tratamento de um carcinoma indiferenciado de nasofaringe. DESCRIÇÃO DO CASO: Um adolescente do gênero masculino, de 14 anos de idade, apresentou-se à clínica odontológica com queixa de dor e pigmentação dos incisivos superiores e inferiores, caninos e pré-molares após ter sido submetido a radioterapia/quimioterapia, declarando seu desejo de remover as manchas escuras na superfície do dentes comprometidos, devido à sua estética bucal. Foi realizado um clareamento dentário com peróxido de hidrogênio, seguido por micro-abrasão. Em um período de dois anos de seguimento, foi observado o sucesso clínico e a satisfação da criança. CONCLUSÃO: A adoção de tais métodos proporciona alternativas eficientes para o restabelecimento de um sorriso saudável, resgatando assim uma imagem facial agradável para o paciente. A minimização do sofrimento é geralmente o foco dos esforços clínicos visando a promoção da saúde psicológica em pacientes que sobreviveram ao câncer.
Subject(s)
Humans , Male , Adolescent , Tooth Bleaching , Tooth Discoloration/etiology , Esthetics, Dental , Nasopharyngeal Neoplasms/drug therapy , Nasopharyngeal Neoplasms/radiotherapyABSTRACT
Several studies have been published concerning Epstein-barr virus (EBV) infection and nasopharyngeal cancer (NPC) development. The incidences of histological types are different according to endemic or non-endemic regions. Latent EBV infection is found in almost all cases of NPC in endemic regions, but normally absent in type I carcinomas, more common in non-endemic regions. AIM: The purpose of this hospital-based study was to analyze the presence of EBV in nasopharyngeal tumor tissues and in peripheral blood of nasopharyngeal cancer patients and healthy individuals, in a low risk, non-endemic area. METHODS: EBV detection in samples of nasopharyngeal cancer patients and healthy individuals. RESULTS: This study indicates that the frequency of EBV positive cases in peripheral blood is higher in advanced tumor stages. CONCLUSIONS: The incidence rates of NPC have a distinct distribution. Since the prevalence of this disease is low in occidental countries, little is known about the biology of these tumors in non-endemic areas. We observed statistically significant differences in EBV detection between the NPC patient group and the control group. This study may help to understand the biological mechanisms of NPC and the correlation of EBV infection with this disease, in a low risk, non-endemic region.
Têm sido publicados vários estudos acerca da infecção por Epstein-Barr vírus (EBV) e o desenvolvimento de carcinoma da nasofaringe (NPC). As prevalências dos tipos histológicos e a presença de infecção latente pelo EBV são diferentes em regiões endémicas e não endémicas. OBJETIVO: O objectivo deste estudo consistiu na detecção de EBV em tecido tumoral da nasofaringe e sangue periférico de doentes com NPC e em indivíduos saudáveis, provenientes duma área não-endémica, de baixo risco. MÉTODOS: Detecção de EBV em amostras de doentes com carcinoma da nasofaringe e indivíduos saudáveis. Neste estudo de série foram avaliadas as implicações clínicas da presença de EBV circulante no sangue periférico de doentes com carcinoma da nasofaringe. RESULTADOS: Este estudo indica que a frequência de casos EBV positivos detectados no sangue periférico é superior em tumores de estádio mais avançado. CONCLUSÕES: Estes resultados indicam que se observam diferenças na pesquisa do vírus Epstein-Barr no grupo de doentes com NPC e no grupo controlo, sem tumor. Este estudo pode ajudar na compreensão dos mecanismos biológicos do cancro da nasofaringe e da correlação destes tumores com a infecção por EBV numa área não-endémica, de baixo risco.