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Nasopharyngeal angiofibroma (NA) primarily affects adolescent males. The incidence of NA in the elderly, however, is extremely low. The present study describes a 72-year-old male with NA that presented with typical symptoms and radiological findings. The location and extension of the tumor was too lateral and inferior to be effectively resected by an endoscopic approach. Therefore, a combination of endoscopic and open approaches was considered. The tumor was completely resected using an image-guided endoscopic-assisted sublabial and buccolabial incision approach. The post-operative histopathological and immunohistochemical analysis confirmed the diagnosis of NA. The present study demonstrated the occurrence of NA in the elderly, and highlighted the potential of an image-guided endoscopic-assisted sublabial and buccolabial incision approach for the treatment of NA in the elderly.
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BACKGROUND: The role of postoperative adjuvant treatment for sinonasal malignant melanoma remains unclear. This study evaluates the impact of three different surgical and postoperative adjuvant treatment modalities: surgery alone(open and endoscopic approaches), surgery plus radiotherapy and surgery, radiotherapy plus chemotherapy on survival of patients with primary sinonasal malignant melanoma (SMM). METHODS: The data of 69 patients who underwent primary surgical treatments at Eye & ENT hospital of Fudan University between January 1st, 2000 and December 31st, 2010 were retrospectively reviewed. Survival comparison of different surgical and postoperative adjuvant treatment modalities (surgery alone, surgery plus radiotherapy and surgery, radiotherapy plus chemotherapy), as well as survival comparison between open and endoscopic surgical approaches were performed. Curves depicting survival were performed using Kaplan-Meier method. Statistical analysis was performed using log-rank test software SPSS19 and p < .05 is considered as statistically significant. RESULTS: The median overall survival time was found to be 18 months for surgery alone (27 cases), 32 months for surgery plus radiotherapy (24 cases), 42 months for surgery, radiotherapy plus chemotherapy (18 cases). The 3 and 5 year survival rates for groups mentioned above were 14.8% and 5.6%, 45.1% and 31.6%, 55% and 32.1%, respectively. Statistical significances were found not only between surgery alone and surgery plus radiotherapy treatment group (P = 0.012), but also surgery alone and surgery, radiotherapy plus chemotherapy group (P = 0.002). There was no statistically significant survival difference found between the two different surgical approaches (41 cases for open approach and 28 cases for endoscopic approach). CONCLUSIONS: Sinonasal malignant melanoma is a disease with a poor prognosis. Patients who underwent surgery plus radiotherapy or surgery, radiotherapy plus chemotherapy had better survival outcomes than those underwent surgery alone. Endoscopic approach provided similar survival outcome as an open approach.
Assuntos
Melanoma/terapia , Neoplasias dos Seios Paranasais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Masculino , Melanoma/mortalidade , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/mortalidade , Neoplasias dos Seios Paranasais/cirurgia , Radioterapia Adjuvante , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: The purpose of this study was to examine endoglin (CD105) expression on microvessel endothelial cells (ECs) in juvenile nasopharyngeal angiofibroma (JNA) and its relationship with recurrence. METHODS: Immunohistochemistry was performed to detect CD105 expression in a tissue microarray from 70 patients with JNA. Correlation between CD105 expression on microvessel ECs and clinicopathological features, as well as tumor recurrence, were analyzed. RESULTS: Immunohistochemistry revealed CD105 expression on ECs but not in stroma of patients with JNA. Chi-square analysis indicated CD105-based microvessel density (MVD) was correlated with JNA recurrence (p = .013). Univariate and multivariate analyses determined that MVD was a significant predictor of time to recurrence (p = .009). The CD105-based MVD was better for predicting disease recurrence (AUROC: 0.673; p = .036) than other clinicopathological features. CONCLUSIONS: MVD is a useful predictor for poor prognosis of patients with JNA after curative resection. Angiogenesis, which may play an important role in the occurrence and development of JNA, is therefore a potential therapeutic target for JNA.
Assuntos
Angiofibroma/irrigação sanguínea , Antígenos CD/metabolismo , Células Endoteliais/metabolismo , Microvasos/citologia , Neoplasias Nasofaríngeas/irrigação sanguínea , Receptores de Superfície Celular/metabolismo , Adolescente , Adulto , Angiofibroma/metabolismo , Angiofibroma/patologia , Angiofibroma/cirurgia , Criança , Endoglina , Humanos , Imuno-Histoquímica , Masculino , Análise Multivariada , Neoplasias Nasofaríngeas/metabolismo , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/cirurgia , Recidiva Local de Neoplasia/metabolismo , Prognóstico , Curva ROC , Análise Serial de Tecidos , Adulto JovemRESUMO
OBJECTIVE: The aim of this study is to evaluate endoscopic assisted sublabial and buccolabial incision approach as treatment option for Juvenile nasopharyngeal angiofibroma (JNA) with extensive infratemporal fossa (ITF) extension. METHODS: Seven patients diagnosed as JNA with extensive ITF extension and underwent surgery at our department between 2006 and 2010 were retrospectively reviewed. All patients underwent diagnostic arteriography followed by embolization preoperatively and intratumor injection with N-butyl cyanoacrylate (NBCA). Endoscopic assisted sublabial and buccolabial incision approach was used to remove the tumors. RESULTS: Complete resections of the tumors were achieved in all patients. Mean blood loss was 700 ml. The follow-up period ranged from 9 to 20 months, with a mean of 14.3 months. One patient had a recurrent tumor six months after operation. CONCLUSIONS: Endoscopic assisted sublabial and buccolabial incision is an optional approach to remove JNA with extensive ITF extension.
Assuntos
Angiofibroma/cirurgia , Endoscopia/métodos , Neoplasias Nasofaríngeas/cirurgia , Osso Temporal/cirurgia , Adolescente , Angiofibroma/patologia , Perda Sanguínea Cirúrgica , Criança , Embolização Terapêutica , Embucrilato/administração & dosagem , Humanos , Injeções , Masculino , Neoplasias Nasofaríngeas/patologia , Invasividade Neoplásica , Estudos Retrospectivos , Osso Temporal/patologiaRESUMO
OBJECTIVE: Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular tumor of the nasopharynx occurring in young males. The aim of this study was attempt to find out the site of origin and the common expansion routes of JNA. METHODS: The CT examinations of 46 untreated patients with histologically proven JNA were retrospectively analyzed. Evidence of tumor spreading of the locations are those following CT characteristics: (a) expansion and/or erosion of bony wall; (b) obliteration of normal fatty planes. In addition, three dimensional reconstruction technology was used to make further study. RESULTS: The pterygoid canal was affected in all untreated cases and therefore was considered as the origin of JNA. Nineteen patients' tumors (41.3%) originated from the front part of pterygoid canal and the other 27 ones (58.7%) from the post part of pterygoid canal. Pterygoid canal, choanae and nasal cavity are the three most common sites of JNA. CONCLUSION: The possible site of origin is pterygoid canal. After originating from this point, the tumor will invade sphenopalatine foramen, sphenoid sinus and pterygopalatine fossa first, and then into adjacent structure through aforementioned three sites.