Cancer-Associated Thrombotic Microangiopathy: Literature Review and Report of Five Cases.

Thrombotic microangiopathy (TMA) is an anatomopathological lesion mediated by endothelial dysfunction and characterized by the creation of microthrombi in small vessels. In patients with cancer, it may be due to toxicity secondary to chemotherapy, tumor embolization, or hematopoietic progenitor transplantation. Cancer-associated TMA is an underestimated entity that generally appears in the final stages of the disease, although it may also be the initial manifestation of an underlying cancer. Support treatment is necessary in all cases and, depending on the cause, different targeted therapies may be used. The prognosis is very poor. In this article we present a comprehensive review of the existing literature on the physiological mechanisms of cancer-associated TMA. Afterwards, five clinical cases will be presented of patients who developed TMA and were diagnosed in our Department in 2023. We present a discussion of the different causes that triggered the condition, the possible reasons behind the underestimation of this pathology, and the measures that may be adopted.

Dolor maxilar en mujer de 36 años con metástasis óseas / Jaw pain in a 36 year old woman with bone metastases

Se presenta el caso clínico de una paciente joven con cáncer de mama y metástasis óseas en tratamiento con bifosfonatos que acude a consulta de Atención Primaria por dolor maxilar. La paciente fue diagnosticada de osteonecrosis secundaria a bifosfonatos. Se exponen asimismo en el artículo los factores de riesgo, fisiopatología, clínica y tratamiento de esta entidad

The clinical case of a young female patient with bone metastases and breast cancer under treatment with bisphosphonates who was evalued in Primary Care due to jaw pain is presented. Bisphosphonate-associated osteonecrosis was diagnosed. We discuss risk factors, pathophysiology, clinical features and management of the disorder

[Survival rate in epidermoid carcinoma of the oral cavity]. / Supervivencia en el carcinoma epidermoide de cavidad oral.

The present study aims to analyse the survival of 94 patients with squamous cell carcinoma of the oral cavity. They were 86 men and 8 women with a mean age of 61. Seventy four percent were smokers and 70% consumed alcohol regularly. Eighty three percent had unhealthy teeth. A great majority of patients (76) were in the advanced stages (III-IV) and 61% showed neck nodules. The overall survival at 5 years was the following: 70% for patients in stage I, 85% in stage II, 58% stage III and only 17% for the patients in stage IV. The most significant prognostic factor that affected the survival was the N stage. For the patients in N0 and N1 we only found significant differences when the lymph nodes were histologically affected by the tumor.

Supervivencia en el carcinoma epidermoide de cavidad oral / Survival in epidermoid carcinoma oral cavity

Presentamos un estudio sobre 94 casos de carcinoma epidermoide de cavidad oral. La muestra consta de 86 varones, con una edad media de 61 años, siendo fumadores el 74 por ciento y bebedores regulares de alcohol el 70 por ciento. El 83 por ciento presentaba un estado buco-dental malo. La mayoría de los casos eran estadios avanzados III-IV (76 por ciento), con un 61 por ciento de adenopatías clínicamente significativas. La supervivencia a 5 años en estadio I fue del 70 por ciento, estadio II 85 por ciento, estadio III 58 por ciento y estadio IV 17 por ciento. Encontramos que la clasificación que tiene mayor valor pronóstico es la evaluación del estado ganglionar, pero en el caso de N0 y N1 la evaluación clínica es insuficiente, siendo necesario el estudio histológico tras la realización del vaciamiento ganglionar oportuno (AU)

The present study aims to analyse the survival of 94 patients with squamous cell carcinoma of the oral cavity. They were 86 men and 8 women with a mean age of 61. Seventy four percent were smokers and 70% consumed alcohol regularly. Eighty three percent had unhealthy teeth. A great majority of patients (76) were in the advanced stages (III-IV) and 61% showed neck nodules. The overall survival at 5 years was the following: 70% for patients in stage I, 85% in stage II, 58% stage III and only 17% for the patients in stage IV. The most significant prognostic factor that affected the survival was the N stage. For the patients in N0 and N1 we only found significant differences when the lymph nodes were histologically affected by the tumor (AU)

Síndrome de cáncer hereditario de mama-ovario y genes de susceptibilidad. El consejo genético con un enfoque médico-psicológico / Hereditary breast-ovarian cancer syndrome and susceptibility genes. A medical- psychological approiach to genetic counseling and testing

El cáncer de mama es la primera causa de muerte por cáncer en mujeres. El factor epidemiológico más importante de riesgo para desarrollar ésta neoplasia es tener una historia familiar de cáncer de mama. El 5 por ciento al 10 por ciento de casos son heredados en forma autosómica dominante. Los individuos predispuestos heredarían una copia funcional y una inactiva del gen de susceptibilidad, y una mutación somática eliminando el alelo funcional eliminaría su función supresora de tumores. Desafortunadamente, el desarrollo de clínicas de consejo genético no es paralelo al de la investigación molecular. Dada la constante evolución de la genética del cáncer existe una imperiosa necesidad de actualización de los médicos debido al interés creciente de la población en riesgo para examinarse para el cáncer hereditario de mama (AU)

[Results of treating cervical metastases of an unknown primary tumor. A report of 29 cases]. / Resultados del tratamiento de las metástasis cervicales de primario no filiado. A propósito de 29 casos.

A retrospective study was made of 29 patients with cervical metastasis of an unknown primary tumor. Sixteen patients received local treatment with surgery and radiotherapy (group A) and 13 patients were treated with induction chemotherapy, surgery and radiotherapy (group B). All patients responded. Local recurrence occurred in 21.4% of group A and 20% of group B. The frequency of distant metastases was similar (18.8% vs 15.4%). The mean survival time of 68 months in group A was longer than the 40 months of group B, and the a 2-year survival rate was 81% in group A and 67% in group B. The 5-year survival was better in group B (56% vs 40%). The primary tumor was identified twice as often in the patients who received only local treatment (group A 37.5% and group B 15.4%). Detection of the primary tumor was the only factor that significantly influenced patient survival.