ABSTRACT
OBJECTIVE: To describe clinical and demographic characteristics of the parapharyngeal space tumors and assess surgical approaches used to treat them at our institution. METHODS: A retrospective and descriptive study of the parapharyngeal space tumors, excluding paragangliomas, treated from June 1991 to October 2002 in a cancer center. The study population included 21 patients, 8 men and 13 women, average age of 41 years (range, 20 to 70 years). Fine needle biopsy was done in 5 (24%) patients. Computed tomography (CT) was performed in all patients, and only a few required magnetic resonance image (MRI). RESULTS: Surgical approaches included transcervical alone or in combination with parotidectomy, transoral, or transmandibular (mandibular swing) approach. Laminectomy and segmentary approaches were also performed in 1 patient each. Sixteen (76%) patients had benign lesions and 5 (24%) had malignant tumors. Neurogenic tumors represented 57% of all tumors. Mean tumor size was of 6.7 cm (range, 3 to 11 cm). Six (29%) patients received adjuvant radiotherapy. Complications occurred in 6 (29%) patients, 4 (19%) of which were nervous injuries associated with peripheral nerve sheath tumors. Median disease-free follow-up survival was 33 months (range, 2 to 184 months) despite being an heterogeneous group of histologies. CONCLUSION: Parapharyngeal space is a rare location for head and neck tumors. Cervical approach should be the first choice for large tumors; transoral approach is reserved for tumors less than 3 cm. Conversion to mandibular swing approach when the cervical approach is not offering proper exposure for tumor resection is indicated. Preoperative histologic diagnosis is not required. Nevertheless, CT scan should always be performed in order to exclude paragangliomas, distinguish prestyloid from poststyloid lesions, and to assess the extension of the tumor as well as its relationship with adjacent structures.
Subject(s)
Nerve Sheath Neoplasms/diagnosis , Neurilemmoma/diagnosis , Pharyngeal Neoplasms/diagnosis , Adenoma, Pleomorphic/diagnosis , Adenoma, Pleomorphic/mortality , Adenoma, Pleomorphic/pathology , Adenoma, Pleomorphic/radiotherapy , Adenoma, Pleomorphic/surgery , Adult , Aged , Biopsy, Fine-Needle , Cancer Care Facilities , Cervical Vertebrae/surgery , Combined Modality Therapy , Disease-Free Survival , Female , Follow-Up Studies , Humans , Laminectomy , Magnetic Resonance Imaging , Male , Mexico , Middle Aged , Nerve Sheath Neoplasms/mortality , Nerve Sheath Neoplasms/pathology , Nerve Sheath Neoplasms/radiotherapy , Nerve Sheath Neoplasms/surgery , Neurilemmoma/mortality , Neurilemmoma/pathology , Neurilemmoma/radiotherapy , Neurilemmoma/surgery , Parotid Gland/pathology , Parotid Gland/surgery , Pharyngeal Neoplasms/mortality , Pharyngeal Neoplasms/radiotherapy , Pharyngeal Neoplasms/surgery , Pharyngectomy/methods , Pharynx/pathology , Postoperative Complications/etiology , Postoperative Complications/mortality , Radiotherapy, Adjuvant , Survival Rate , Tomography, X-Ray ComputedABSTRACT
We report two cases of vulvar sarcomas that are our Institutional experience in 29 years. The first case was a teenager of 14 years-old with a low grade leiomyosarcoma surgically treated. Along a 22 years follow-up the disease has had four local recurrences of more than 5 cm each one: two after surgery and two after surgery plus chemotherapy and surgery plus radiotherapy respectively. She is alive disease evidence after two years from the last combined treatment. The second one, was a 26 years-old patient with a malignant schwannoma of 12 cm in diameter treated with combined radical surgery, radiotherapy, and chemotherapy. She is alive and without disease evidence 52 months after surgery. We emphasized that these tumors are very rare and the fact that the first patient is the youngest and with more years of follow up according the bibliography consulted. Treatment of vulvar sarcomas is radical local excision followed mainly by radiotherapy with infiltrating margins. The value of postoperative adjuvant chemotherapy is uncertain. According to the natural history and behavior of vulvar sarcomas, we conclude that the elective treatment of these tumors should be carry out in institutions of high level.
Subject(s)
Leiomyosarcoma , Neurilemmoma , Vulvar Neoplasms , Abdominal Neoplasms/drug therapy , Abdominal Neoplasms/radiotherapy , Abdominal Neoplasms/secondary , Adolescent , Adult , Antineoplastic Agents, Alkylating/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bartholin's Glands , Chemotherapy, Adjuvant , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Cystectomy , Cysts/diagnosis , Dacarbazine/administration & dosage , Dacarbazine/therapeutic use , Diagnosis, Differential , Disease-Free Survival , Doxorubicin/administration & dosage , Female , Follow-Up Studies , Humans , Leiomyosarcoma/diagnosis , Leiomyosarcoma/drug therapy , Leiomyosarcoma/radiotherapy , Leiomyosarcoma/secondary , Leiomyosarcoma/surgery , Neoplasm Recurrence, Local , Neurilemmoma/drug therapy , Neurilemmoma/radiotherapy , Neurilemmoma/surgery , Pelvic Neoplasms/drug therapy , Pelvic Neoplasms/radiotherapy , Pelvic Neoplasms/secondary , Radioisotope Teletherapy , Retrospective Studies , Treatment Outcome , Urinary Bladder Neoplasms/secondary , Urinary Bladder Neoplasms/surgery , Vulvar Neoplasms/diagnosis , Vulvar Neoplasms/drug therapy , Vulvar Neoplasms/pathology , Vulvar Neoplasms/radiotherapy , Vulvar Neoplasms/surgeryABSTRACT
Se presenta un caso de neurofibromatosis tipo I que desarrolló un schwannoma maligno pleuropulmonar. Se puntualiza el potencial maligno de la enfermedad, que suele ser diagnosticada por el dermatólogo, debido al compromiso cutáneo temprano
Subject(s)
Humans , Male , Adult , Neurilemmoma , Neurilemmoma/diagnosis , Neurilemmoma/genetics , Neurilemmoma/radiotherapy , Neurofibromatosis 1/diagnosis , Lung/pathology , LungABSTRACT
Se presenta un caso de neurofibromatosis tipo I que desarrolló un schwannoma maligno pleuropulmonar. Se puntualiza el potencial maligno de la enfermedad, que suele ser diagnosticada por el dermatólogo, debido al compromiso cutáneo temprano(AU)