Angiofibroma nasofaríngeo juvenil: estudio de 6 casos en el Hospital Carlos van Buren de Chile / Juvenile nasopharyngeal angiofibroma: study of 6 cases in the Carlos van Buren Hospital in Chile

Introducción: El angiofibroma nasofaríngeo juvenil es una neoplasia vascular benigna y localmente agresiva, que se desarrolla casi exclusivamente en adolescentes de sexo masculino. Sus manifestaciones clínicas habituales son epistaxis y obstrucción nasal. Objetivo: Dar a conocer la experiencia en el Servicio de Otorrinolaringología del Hospital Carlos van Buren de pacientes con angiofibroma operados por vía endoscópica y abierta entre los años 2008 y 2015. Material y método: Estudio descriptivo retrospectivo de pacientes con diagnóstico de angiofibroma nasofaríngeo juvenil que ingresaron al Servicio de Otorrinolaringología del Hospital Carlos van Buren entre los años 2008 y 2015. Resultados: Hubo un total de 6 casos. La edad de los pacientes fluctuó entre los 12 y los 29 años, el 100% fueron pacientes masculinos. Los síntomas de presentación más frecuente fueron epistaxis recurrente y obstrucción nasal, presentes en 5/6 de los pacientes. La totalidad de los casos fueron estudiados con TC, RM y angiografía. El manejo en todos los casos fue con embolización endovascular 48 horas previo a la resección. Conclusión: Los resultados obtenidos se correlacionan con la literatura. El abordaje endoscópico sigue siendo de elección. Este tiene como ventajas menores pérdidas sanguíneas intraoperatorias, una disminución del número días de hospitalización y las tasas de recurrencia.

Introduction: Juvenile nasopharyngeal angiofibroma is a benign vascular neoplasm, locally aggressive that develops almost exclusively in adolescent males. Its usual clinical manifestations are epistaxis and nasal obstruction. Aim: To show the experience in the Department of Otolaryngology Hospital Carlos van Buren of angiofibromas operated by endoscopic and open surgery between the years 2008 and 2015, and review of the literature. Material and Method: Retrospective descriptive study of patients diagnosed with juvenile nasopharyngeal angiofibroma admitted in the Department of Otolaryngology Hospital Carlos van Buren, Valparaiso between 2008 and 2015. Results: A total of 6 cases were identified. The age of patients ranged from 12 to 29 years. The most common presenting symptoms were recurrent epistaxis and nasal obstruction, both present in 5/6 of patients. All the cases were studied with CT, MRI and angiography. All cases had pre-surgical endovascular embolisation48 hours prior to excision. Conclusions: The results correlate with those seen in the literature. The endoscopic approach is the better option, because of its lower intraoperative blood loss, days of hospitalization and recurrence.

Molecular pathogenesis of juvenile nasopharyngeal angiofibroma in brazilian patients.

Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx that accounts for 0.5% of all cancers of the head and neck. It primarily affects males aged 14-25 years. Of the many genes that mediate the development of JNA, GSTM1 has been most frequently associated with this vascular tumor. The loss of expression of GSTM1 (null genotype) is linked to the development of these tumors. The aim of this cross-sectional case study was to examine the prevalence of the GSTM1-null genotype in Brazilian patients with JNA. DNA was extracted from the leukocytes of blood samples from 10 patients. GSTM1 genotypes were analyzed using a PCR-based assay that was designed to identify the wild-type allele of GSTM1. All 10 patients (100%) were males, with a mean age of 17.8 years. The null genotype for GSTM1 was noted in 4 patients (40%)-1 (10%) at Fisch stage I, 1 (10%) at stage III, and 2 (20%) at stage II. No patient with this genotype had stage IV disease. There was no correlation between Fisch classification and GSTM1 genotype (P = .5695). The correlation between age at diagnosis and GSTM1 genotype was not significant (P = .728). The present findings indicate that there is evidence of an association between the GSTM1-null genotype and JNA in this studied Brazilian population.

Outcomes and prognostic factors of conformal radiotherapy versus intensity-modulated radiotherapy for nasopharyngeal carcinoma.

INTRODUCTION: This study retrospectively compared outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated with conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: The treatment records of 182 patients treated with IMRT and 198 patients treated with CRT from April 2005 to December 2007 in our hospital were reviewed. The clinical characteristics, treatment outcomes (including survival analysis and acute and late toxicity), and prognostic factors of the two groups were compared. RESULTS: The 4-year local-regional control (LRC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) of the IMRT and CRT groups were 93.6 and 85.3 %, 79.1 and 73.6 %, 74.7 and 65.0 %, and 83.5 and 72.1 %, respectively. The acute radiation dermatitis and xerostomia of the two groups were significantly different (P < 0.05). In the IMRT group, OS between different T stages could not be well separated. Multivariate analysis revealed that, in the CRT group, the clinical stage and T and N stages were significant prognostic factors for OS, DMFS, and DFS and that T stage was a significant prognostic factor for LRC. In the IMRT group, T and N stages had no predictive value for outcomes. CONCLUSIONS: Compared with CRT, IMRT has a better prognosis and less adverse effects. For IMRT, T stage was not a significant prognostic factor for LRC, DMFS, DFS, or OS. An effective treatment strategy is needed for distant control. With the increasing use of IMRT and continued modulation of treatment strategies for NPC, the current staging system faces great challenges.

Nasoangiofibroma juvenil: nuestra experiencia en los últimos 10 años y revisión de la literatura / Juvenile nasopharyngeal angiofibroma: our experience in the last 10 years and review of the literature

Introducción: El nasoangiofibroma juvenil es un tumor benigno con comportamiento de agresividad local, dadas las importantes epistaxis que provoca, la frecuente recidiva local y la complejidad terapéutica que se presenta ante esta patología; se presenta exclusivamente en hombres adolescentes y corresponde al 0,5 por ciento-0,05 por ciento de todos los tumores de cabeza y cuello. Objetivo: Determinar el manejo y las características del paciente con el diagnóstico de nasoagiofibroma juvenil que acude a nuestro servicio. Evaluar necesidad de transfusión sanguínea. Exponer las complicaciones encontradas. Material y método: Se realizó un trabajo retrospectivo observacional de corte transversal de pacientes con diagnóstico de nasoangiofibroma juvenil (NAJ), confirmado por estudios histológicos en la Cátedra de Otorrinolaringología de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, desde enero de 1998 hasta septiembre de 2008. Resultados: Con un total de 45, de los cuales 44 recibieron tratamiento quirúrgico. El rango de edad estaba comprendido entre 7 a 34 años, con una mediana de 16 años y un promedio de 17 años, todos de sexo masculino. Se presentaron con mayor frecuencia en estadio Fisch II, rango de evolución sintomática de 1 a 60 meses, con una mediana de 7 meses de evolución de epistaxis recurrente, obstrucción nasal y rinorrea. La mayoría de grupo sanguíneo O Rh+, provenientes del Departamento Central, recibiendo como tratamiento la resección endoscópica. Siete pacientes presentaron recidivas, con una mediana de 7 meses desde el tratamiento. En 58,8 por ciento de los procedimientos quirúrgicos fue necesaria la transfusión de derivados sanguíneos. Conclusión: Los pacientes que acuden al servicio con el diagnóstico de nasoangiofibroma juvenil, son sometidos a tratamiento quirúrgico en la totalidad de los casos. En la mayoría de los casos se requirió algún tipo de transfusión sanguínea. No hubo complicaciones por...

Introduction: The juvenile Nasopharyngeal Angiofibroma is a benign tumor with behavior of local aggressiveness, given the important epistaxis that it provokes, the frequent local recidiva and the therapeutic complexity that one presents before this pathology; he appears exclusively in teen men and corresponds to 0,5 percent-0,05 percent of all the tumors of head and neck. Aim: To determine the managing and the characteristics of the patient with juvenile Nasopharyngeal Angiofibroma diagnosis that comes to our service. To evaluate need of blood transfusion. To expose the opposing complications. Material and method: There realized a retrospective work observacional of patients' transverse court (cut) with diagnosis of juvenile Nasopharyngeal Angiofibroma (NAJ), confirmed by histological studies in the Service of Otolaryngology of the Asuncion's National University, from January, 1998 until September, 2008. Results: With a whole of 45, of which 44 received surgical treatment. The range of age was understood (included) between (among) 7 to 34 years, with a median of 16 years and an average of 17 years, all of masculine sex. Appellants presented with major frequency in estadio Fisch II, range of symptomatic evolution from 1 to 60 months, with a median of 7 months of evolution of epistaxis, nasal obstruction and rinorrea. The majority of blood group O Rh +, from the Central department, receiving as treatment the resection endoscopic. 7 patients presented recidivas, with a median of 7 months from the treatment. In 58,8 percent of the surgical procedures there was necessary the transfusion of blood derivatives. Conclusion: The patients who come to the service with juvenile nasopharyngeal angiofibroma diagnosis, are submitted to surgical treatment in the totality of the cases. In most cases there was needed some type of blood transfusion. There were no complications for the surgical procedure.

Biópsia de nasofaringe em Serviço de Otorrinolaringologia: correlação clínico histopatológico / Nasopharyngeal biosy in an Otorhinolaryngology Service: clinical histopathological correlation

Os tumores de nasofaringe são afecções raras. Devido à grande diversidade de lesões dessa região, todos os pacientes com suspeita de tumor em nasofaringe devem se submeter a exame endoscópico nasal e biópsia...

Nasopharyngeal neoplasm are rare diseases. Due to great diversity of lesions affecting this area, all patients suspected to have a nasopharyngeal neoplasm should be submitted to nasal endoscopy and biopsy...

Orbital involvement in juvenile nasopharyngeal angiofibroma: prevalence and treatment.

PURPOSE: To assess the prevalence of orbital invasion by juvenile nasoangiofibroma and to discuss its surgical treatment. METHODS: A retrospective review of the medical records and tomographic scans of a case series of 19 patients with juvenile nasoangiofibroma was performed. All scans were reviewed by a radiologist and an orbital surgeon. The presence of the tumor was assessed in the pterygopalatine fossa, nasal cavity, nasopharynx, paranasal sinuses, inferior orbital fissure, orbit, and middle cranial fossa. RESULTS: The most common structures invaded were pterygopalatine fossa (100%), nasal cavity (94.7%), sphenoid sinus (84.2%), and nasopharynx (73.7%). The orbit was invaded in 6 (31.6%) patients. In 5 of these patients, the tumor extended in the orbit through the inferior orbital fissure. Four patients with orbital invasion were successfully operated with the Le Fort I approach. CONCLUSIONS: Orbital involvement is relatively common in the setting of juvenile nasoangiofibroma extension. The main route of orbital invasion is the inferior orbital fissure. The Le Fort I osteotomy is an adequate approach for managing juvenile nasoangiofibroma when it invades the orbit.

Clinical features of nasopharyngeal carcinoma in Jamaica.

Nasopharyngeal carcinoma is endemic in China, Hong Kong, and the Philippines. However, this disease is rare in North America and the Caribbean. This paper discusses the clinical features, prognosis, treatment outcomes, and survival rates of nasopharyngeal carcinoma in Jamaica. The incidence in Jamaica is 1.4 per 100,000. The National Cancer Registry in Jamaica keeps a record of all cancers. A retrospective cohort study of patients with nasopharyngeal carcinoma between 1988-2000 was reviewed. The presenting features, staging, histological diagnosis, treatment, and patient outcome were assessed. All patients received radiation therapy, and 89% of the patients completed the course of therapy. Seventeen percent received chemotherapy, consisting of cisplatin and 5-fluorouracil. Surgery played a minor role in the definitive management of nasopharyngeal carcinoma in this study. Three-year survival rates were 21%. The study demonstrates findings unique to the Caribbean nation of Jamaica. There is a bimodal pattern to the age distribution typical in non-endemic areas, such as shown in this study. Nasopharyngeal carcinoma evades early diagnosis because of its anatomic location and varied symptomatology. Prognostic indicators include intracranial extension, cervical node, and distant metastasis.

[Lymphoepithelioma-like carcinoma of the esophagus: description of a case]. / Carcinoma simil linfoepitelioma (LELC) dell'esofago: descrizione di un caso.

The authors describe a case of lymphoepithelioma-like carcinoma (LELC) of the esophagus occurring in a 77-year-old man. To date, 13 cases have been described in the literature, all in natives of Japan. Histological features, immunohistochemical findings and differential diagnosis are discussed. In our case epithelial neoplastic cells were completely negative for the EBV genome.

Seroprevalence of human herpesvirus-8 (HHV-8) in countries of Southeast Asia compared to the USA, the Caribbean and Africa

Seroprevalence of HHV-8 has been studied in Malaysia, India, Sri Lanka, Thailand, Trinidad, Jamaica and the USA, in both healthy individuals and those infected with HIV. Seroprevalence was found to be low in these countries. In contrast, the African countries of Ghana, Uganda and Zambia showed high seroprevalences in both healthy and HIV-infected populations. This suggests that human herpes virus-8 (HHV-8) may be either a recently introduced virus or one that has extremely low infectivity. Nasopharyngeal and oral carcinoma patients from Malaysia, Hong Kong and Sri Lanka who have very high EBV titres to show that only 3/82 (3.7 percent) have antibody to HHV-8, demonstrating that there is little, if any, cross-relativity between antibodies to these two gamma viruses. (AU)

The biology and pathology of selected skull base tumors.

This paper describes the pathobiology of some of the more common skull base tumors. In addition to clinicopathologic features, emphasis is placed upon methods of diagnosis utilizing immunoperoxidase stains and molecular markers that may or may not impact upon prognosis.

Aspectos epidemiológicos do carcinoma da nasofaringe / Epidemiological aspects of the nasopharyngeal carcinoma

Este estudo apresenta 39 doentes com câncer de nasofaringe (NPC), que foram revisados sob os aspectos epidemiológicos. Todos os casos foram estudados no período de 1979-1989, com uma investigaçäo clínica, neurológica e radiológica e os dados foram analisados, tendo em vista a idade, sexo, origem étnica, primeiros sinais, apresentaçäo clínica, pares cranianos evolvidos, perda de peso, associaçäo com consumo de álcool e fumo e distribuiçäo histológica.

Tumores de la nasofaringe: análisis de casos años 1960-1991 / Nasopharynx tumors: analysis of cases years 1960-1991

Analisis retrospectivo de 20 casos tratados en el Hospital Central de las FFAA. Las adenomegalias fueron universales en el 100 por ciento (20-20). El 80 por ciento (16-20) fueron malignos, y entre estos el 62,50 por ciento epidermoides. Como estadio III se clasificó el 50 por ciento de los casos (8-16). Recibieron radioterapia todos los pacientes, con una tasa de respuesta parcial del 43.75 por ciento (7-16). Recibieron además de la radioterapia, drogas antineoplásicas 6 pacientes con una tasa de respuesta parcial del 50 por ciento (3-6). La sobrevida actuarial a los 5 años fue del 40 por ciento . Se concluye en la necesidad de diagnóstico precoz, buena técnica del tratamiento radiante y manejo interdisciplinario

Cancer among Haitians in Florida.

Data on cancer rates from West Indian populations are scarce, and to the authors' knowledge there are no published data on cancer rates and distributions among Haitians. Proportional distributions of cancers among three groups of patients living in Florida were compared: Haitian born blacks, United States born blacks, and non-Haitian Caribbean born blacks. The incidence rate of cancer of the cervix among the Haitian and United States born black groups was also compared. Increased rates of certain malignancies associated with viral infection or immunodeficiency were found in the Haitian group. These tumors were hepatocellular carcinoma, nasopharyngeal carcinoma, reticulum cell sarcoma, Kaposi's sarcoma, and carcinoma of the uterine cervix. The age-adjusted incidence rate of carcinoma of the cervix was especially high among Haitian women even with a liberal estimate of the female Haitian population from whom the cases were drawn. Except for cancer of the cervix, the numbers of cancers of interest were small, and age-adjusted incidence rates were not calculated. Continued epidemiological study of larger numbers of patients is needed to evaluate these findings further.

Cancer of nasopharynx in young patients.

From 1961 to 1980 17 patients with nasopharyngeal carcinoma who were less than 30 years old at time of diagnosis were treated at the two oncologic hospitals in Puerto Rico. Fourteen of the tumors were lymphoepitheliomas and the remaining three were anaplastic carcinomas. Ninety-four percent of the patients were found to have neck adenopathy at the initial examination and in 65% of them the adenopathy was bilateral. The 5-year actuarial survival was 14. The main cause of failure was the distant metastasis. Seventy-one percent of our patients developed distant metastasis sometime during the course of their disease. Carcinoma of the nasopharynx is uncommon in Puerto Rico as in other western countries. The post-adolescent age incidence peak reported from different countries is also present among Puerto Ricans.

Estudo epidemiologico, terapeutico e de relaçäo com o virus Epstein e Barr, do cancer da nasofaringe em Säo Paulo, Brasil: estudo epidemiologico do cancer da nasofaringe; parte 2 / Epidemiological therapeutic and relation study with Epstein Barr virus nasopharyngeal cancer in Sao Paulo-Brasil: epidemiological study of nasopharyngeal cancer; part II

No estudo epidemiológico, terapêutico e de relaçäo com o virus Epstein e Barr do câncer da nasofaringe em Säo Paulo-Brasil, säo analisados: a) anatomia do rinofaringe, b) incidência, frequência, distribuiçäo etária e racial, c) etiologia, d) estudo clínico e patológico, e) terapeutica, f) prognostico e resultados, g) instrumental para exame e biopsia e, h) relaçäo com o virus Epstein-Barr

Contrast study of the nasopharynx experience in Suriname

Describes a contrast study of the nasopharynx, which was studied in 24 cases. Benign lesions occurred in 8 cases, while all other cases suffered from malignant neoplasms. An attempt is made to discuss the incidence and epidemiology of nasopharyngeal neoplasms. All types of nasopharyngeal mass lesions, especially neoplasms, are covered. Two roentgenograms, a subments-vertical and one lateral, were taken from each subject. Different types of radiological pictures, characteristic for different histopathological lesions, are described. The prediction of the histopathological nature of the lesions was made possible by considering the typical filling defect in nasopharyngographic pictures. In combination with other methods of examination, the contrast study should be able to detect early nasopharyngeal cancer. A good correlation is possible between contrast examination and clinical and histopathological examination. Contrast study of the nasopharynx should be done routinely in the staging of Hodgkin's disease, but also at certain intervals, to evaluate radiography response in nasopharyngeal neoplasms

Risk factors associated with nasopharyngeal carcinoma.

We performed a case-control study of nasopharyngeal squamous-cell carcinoma to identify risk factors associated with the disease. Interviews with 156 patients and 267 controls revealed that increased risk was significantly associated with a prior history of ear, nose or throat disease (relative risk = 1.8, P = 0.006) and occupational exposure to fumes (relative risk = 2.0, P = 0.006), smoke (relative risk = 3.0, P = 0.008) and chemicals (relative risk = 2.4, P = 0.006). Among Chinese, other Asians and Mexican-Americans, increased risk was also associated with foreign birthplace (relative risk = 2.1, P = 0.04), probably reflecting childhood exposure to carcinogens in inhaled smoke. In Chinese patients the risk associated with foreign birthplace and occupational exposure increased among those with HLA-A2 and less than two antigens at the B locus, suggesting a genetic variation in susceptibility.