Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity / Infiltrado peritumoral no prognóstico do carcinoma epidermoide de cavidade oral

INTRODUCTION: Patients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor.OBJECTIVES: To evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval.METHODS: The study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes.RESULTS: This study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the "minor inflammatory" and "major inflammatory" processes, with p = 0.14 and p = 0.24, respectively. A direct association between age and inflammation (p = 0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p = 0.01).CONCLUSION: Although associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.

INTRODUÇÃO: Pacientes com carcinoma epidermoide de cavidade oral mostram déficits em sua imunidade celular, que contribuem para o crescimento neoplásico. Assim, a atividade inflamatória, como resposta imunológica ao tumor, pode servir como fator prognóstico.OBJETIVOS: Avaliar a correlação entre o processo inflamatório peritumoral com as características clínicas dos pacientes, com a sobrevida e com o tempo livre de doença.MÉTODO: A amostra deste estudo foi composta por uma coorte retrospectiva de base hospitalar com pacientes submetidos à cirurgia para remoção de carcinoma epidermoide de cavidade oral. O infiltrado inflamatório presente nas lâminas foi avaliado semi quantitativamente, sendo dividido em processo inflamatório: menor e maior.RESULTADOS: Analisaram-se 57 amostras tumorais, com infiltrado de linfócitos, plasmócitos e histiócitos. O teste log-rank não mostrou significância para as curvas de sobrevida e de recidiva dos processos "inflamatório menor" e "inflamatório maior", p = 0,14 e p = 0,24, respectivamente. Observou-se associação direta da idade com o processo inflamatório (p = 0,04), e relação indireta entre o grau de diferenciação tumoral e o processo inflamatório (p = 0,01).CONCLUSÃO: O processo inflamatório peritumoral, embora relacionado com a diferenciação histológica, não pode ser considerado fator prognóstico de carcinoma epidermoide de cavidade oral, pois não se relaciona com sobrevida e tempo livre da doença.

Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity.

INTRODUCTION: Patients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor. OBJECTIVES: To evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval. METHODS: The study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes. RESULTS: This study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the "minor inflammatory" and "major inflammatory" processes, with p=0.14 and p=0.24, respectively. A direct association between age and inflammation (p=0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p=0.01). CONCLUSION: Although associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.

Expression of cancer-testis antigens MAGE-A4 and MAGE-C1 in oral squamous cell carcinoma.

BACKGROUND: Tumor markers are genes or their products expressed exclusively or preferentially in tumor cells and cancer-testis antigens (CTAs) form a group of genes with a typical expression pattern expressed in a variety of malignant neoplasms. CTAs are considered potential targets for cancer vaccines. It is possible that the CTA MAGE-A4 (melanoma antigen) and MAGE-C1 are expressed in carcinoma of the oral cavity and are related with survival. METHODS: This study involved immunohistochemical analysis of 23 patients with oral squamous cell carcinoma (SCC) and was carried out using antibodies for MAGE-A4 and MAGE-C1. Fisher's exact test and log-rank test were used to evaluate the results. RESULTS: The expression of the MAGE-A4 and MAGE-C1 were 56.5% and 47.8% without statistical difference in studied variables and survival. CONCLUSION: The expression of at least 1 CTA was present in 78.3% of the patients, however, without correlation with clinicopathologic variables and survival.

Agenesia de lobo direito e istmo de glândula tireóide / Right lobe and isthmus agenesis of the thyroid gland

A hemiagenesia de tireóide é uma anormalidade rara na qual um lobo ou um lobo e istmo de tireóide não se desenvolvem. Acredita-se que seja devido a um distúrbio na lobulação ou na descida da glândula de seu local de origem no soalho da faringe. Sua real prevalência é desconhecida, mas estima-se que esteja entre 0,05 a 0,2%. O diagnóstico dessa condição é feito, geralmente, de forma incidental, durante a investigação de outras doenças da tireóide. Relatamos um caso de uma paciente, com bócio adenomatoso em lobo esquerdo e agenesia de lobo direito e istmo de tireóide.

Thyroid hemiagenesis is a rare congenital anomaly, in which thyroid lobe or thyroid lobe and isthmus do not develop. It presumably occurs because of disturb in the lobulation or in the descent of the gland from its origin in the pharyngeal floor. The true prevalence of thyroid hemiagenesis is difficult to determine, but it is believed between 0.05 and 0.2%. The diagnosis of this condition is done generally incidentally during the investigation of another thyroid disease. We report a case of a patient with goiter in the left thyroid lobe and right lobe and isthmus agenesis.

Fatores prognósticos no carcinoma espinocelular de cavidade oral / Prognostic factors in squamous cell carcinoma of the oral cavity

Devido à incerteza da evolução do câncer oral é que os pesquisadores procuram fatores que possam influenciar no prognóstico. OBJETIVO: Avaliar em pacientes com carcinoma espinocelular de cavidade oral variáveis que possam influenciar no tempo de sobrevida. MATERIAIS E MÉTODOS: Analisados dados de 45 pacientes no período de Janeiro de 2001 a Janeiro de 2006. As curvas de sobrevida foram estimadas pelo método de Kaplan-Meier e para compará-las os testes de log-rank e o modelo de regressão de Cox. Desenho do Estudo: Análise retrospectiva. RESULTADOS: A sobrevida global foi de 39 por cento em 5 anos. Apenas as variáveis, metástase cervical (p=0,017), radioterapia pós-operatória (p=0,056) e margens comprometidas (p=0,004) tiveram significância estatística. A sobrevida foi menor em pacientes: com metástase cervical; com margens comprometidas e os submetidos à radioterapia pós-operatória, ou seja, nos tumores mais agressivos. Após ajustamento, a radioterapia não mostrou significância estatística. Provavelmente a sobrevida de 39 por cento seja pelo elevado número de pacientes com metástase (52,2 por cento) e pelo fato da amostra ser basicamente de cânceres de língua e assoalho (82 por cento), os de controle mais difícil. CONCLUSÃO: A metástase cervical e o comprometimento das margens cirúrgicas são os fatores prognósticos no carcinoma de cavidade oral que influenciaram na sobrevida.

Researchers have been looking for factors that can influence the prognosis of oral cancer, because its outcome is highly uncertain. AIM: To evaluate variables that can impact the survival rate of patients with squamous-cell carcinoma of the oral cavity. MATERIAL AND METHODS: Data analysis of 45 patients from January, 2001 to January, 2006. Survival rate curves have been estimated using the Kaplan-Meier method and they have been compared through the log-rank test and the Cox regression standard. Study design: Retrospective analysis. RESULTS: Total five-year survival rate was of 39 percent fpr these patients. Only the neck metastases (p=0.017), postoperative radiotherapy (p=0.056) and diseased margin(p=0.004) variables had statistic relevance. Survival rate was lower in patients with neck metastases, margins involved and those who underwent postoperative radiotherapy, in other words, those with the most aggressive tumors. After adjustment, radiotherapy did not prove to be statistically relevant. It is likely that the survival rate of 39 percent was due to the high number of patients with metastasis (52 percent) and because the samples were mostly of tongue and mouth floor diseases (82 percent), which are the hardest to control. CONCLUSION: Neck metastases and diseased margins of oral cavity carcinomas are the prognostic factors that can most impact the survival rate.

Aspectos clínicos e histopatológicos de tumores de palato mole / Clinical and histopathological aspects of soft palate tumors

Introdução: Os tumores do palato mole podem ser classificados de acordo com seu comportamento em benignos e malignos. Os tumores benignos mais freqüentes são os papilomas, os tumores mistos (adenoma pleomórfico) e os schwannomas. Entre os tumores malignos, 95% são carcinomas espinocelulares e os outros 5% agrupam os tumores de glândulas salivares menores, linfomas, melanomas e outras entidades raras. Objetivo: O objetivo deste trabalho foi avaliar a ocorrência de tumores malignos e benignos de palato mole, bem como os tipos de tumores mais freqüentes em cada um destes dois grupos e relacioná-los com a faixa etária, sexo e aspecto macroscópico das lesões. Método: Foi realizada uma análise retrospectiva entre os anos de 1995 e 2005 dos pacientes atendidos no ambulatório de Cirurgia de Cabeça e Pescoço da Instituição. Resultados: Dos 43 pacientes, 10 apresentaram tumores malignos (23%) e 33 pacientes tumores benignos (77%). Dentre todos os tipos de tumores, 26 eram papilomas (60,5%); 9 eram carcinomas espinocelulares (21%); 4 eram hemangiomas (9,3%); 2 eram adenomas pleomórficos (4,6%); 1 era adenocarcinoma (2,3%) e 1 era lipoma (2,3%). Conclusão: Observou-se um predomínio de neoplasias de origem epitelial, tanto nos tumores benignos quanto nos malignos, o que é devido à maior proporção de tecido epitelial em relação aos demais no palato mole.

Introduction: The tumors of the soft palate can be classified according to its benign and malignant behavior. The most frequent benign tumors are the papillomas; the mixed tumors (pleomorphic adenoma) and the schwanomas. Among malignant tumors, 95% are squamous cell carcinoma and the 5% left are represented by minor salivary glands tumors, lymphomas, melanomas and other rare entities. Objective: The objective of this work was to evaluate the frequency of benign and malignant tumors of the soft palate, as well the most frequent kinds of tumors in each group and to relate them with age, gender and macroscopic aspect. Method: A retrospective analysis included the patients seen at the Head and Neck Surgery clinic of the Institution. Results: From the 43 patients, 10 of them presented malignant tumors (23%) and 33 presented benign tumors (77%). Among all of the tumors, 26 were papillomas (60.5%); 9 were squamous cell carcinomas (21%); 4 were hemangiomas (9.3%); 2 were pleomorphic adenomas (4.6%); 1 was adenocarcinoma (2.3%) and 1 was lipoma (2.3%). Conclusion: It was noticed that epithelial tumors are the most frequent in both malignant and benign groups, what is related to the predominant epithelial tissue in soft palate.

Mandibular ameloblastoma treated by bone resection and immediate reconstruction.

Multicystic ameloblastoma mainly affects adult patients between the third and seventh decades of life, frequently in the posterior region of the mandible. The resection of a mandible segment without adequate reconstruction produces serious esthetic and functional sequelae leading to a loss of quality of life. The objective of this study is to show that multidisciplinary treatment of ameloblastomas helps in total lesion excision associated with complete reconstruction of the damaged area. We present a 47-year-old male patient with an ameloblastoma in the posterior mandible who was treated with complete resection of a mandibular segment. Reconstruction, carried out during the same surgical procedure, was performed using an iliac crest bone graft fixed with titanium plates and screws. Rehabilitation was completed eight months later with teeth implants in the grafted area. The advantages of this procedure include recurrence risk reduction due to segmental resection, reliable mandibular reconstruction and less surgical procedures, allowing full rehabilitation within a shorter period of time.

Carcinoma de paratireóide / Parathyroid carcinoma

O carcinoma de paratireóide uma neoplasia incomum. Corresponde a menos de 1 por cento dos casos de hiperparatireoidismo primário. Manifesta-se por hipercalcemia severa e mais de 50 por cento dos pacientes terão doença renal ou óssea concomitante...

Parathiroid carcinoma is a incommon malignancy. It accounts for less than one per cent of cases of primary hyperparathiroidism. It is manifested by severe hypercalcemia and up to 50 per cent of patients will have concomitant kidney or bone disease...

Ameloblastoma mandibular tratado por ressecção óssea e reconstrução imediata / Mandibular ameloblastoma treated by bone resection and imediate reconstruction

O ameloblastoma multicístico acomete principalmente pacientes adultos, entre a terceira e a sétima década de vida, freqüentemente na região posterior de mandíbula. A ressecção de um segmento mandibular, sem reconstrução adequada, produz grave seqüela estética e funcional levando a uma perda da qualidade de vida. O objetivo desta apresentação é mostrar que o tratamento multidisciplinar do ameloblastoma possibilita radicalidade oncológica associada à completa reconstrução da área lesada. Apresentamos um paciente de 47 anos, acometido por um ameloblastoma em região posterior de mandíbula tratado com ressecção completa de um segmento mandibular. A reconstrução no mesmo tempo operatório utilizou enxerto ósseo de crista ilíaca fixado com placas e parafusos de titânio. Após oito meses completou-se a reabilitação com implantes de elementos dentários na área do enxerto. As vantagens deste procedimento incluem a diminuição do risco de recidivas pelo uso da ressecção segmentar, reconstrução mandibular confiável e diminuição do número de procedimentos cirúrgicos, permitindo completa reabilitação em um período mais curto de tempo.

Multicystic ameloblastoma mainly affects adult patients between the third and seventh decades of life, frequently in the posterior region of the mandible. The resection of a mandible segment without adequate reconstruction produces serious esthetic and functional sequelae leading to a loss of quality of life. The objective of this study is to show that multidisciplinary treatment of ameloblastomas helps in total lesion excision associated with complete reconstruction of the damaged area. We present a 47-year-old male patient with an ameloblastoma in the posterior mandible who was treated with complete resection of a mandibular segment. Reconstruction, carried out during the same surgical procedure, was performed using an iliac crest bone graft fixed with titanium plates and screws. Rehabilitation was completed eight months later with teeth implants in the grafted area. The advantages of this procedure include recurrence risk reduction due to segmental resection, reliable mandibular reconstruction and less surgical procedures, allowing full rehabilitation within a shorter period of time.

Prognostic factors in squamous cell carcinoma of the oral cavity.

UNLABELLED: Researchers have been looking for factors that can influence the prognosis of oral cancer, because its outcome is highly uncertain. AIM: To evaluate variables that can impact the survival rate of patients with squamous-cell carcinoma of the oral cavity. MATERIAL AND METHODS: Data analysis of 45 patients from January, 2001 to January, 2006. Survival rate curves have been estimated using the Kaplan-Meier method and they have been compared through the log-rank test and the Cox regression standard. STUDY DESIGN: Retrospective analysis. RESULTS: Total five-year survival rate was of 39% fpr these patients. Only the neck metastases (p=0.017), postoperative radiotherapy (p=0.056) and diseased margin(p=0.004) variables had statistic relevance. Survival rate was lower in patients with neck metastases, margins involved and those who underwent postoperative radiotherapy, in other words, those with the most aggressive tumors. After adjustment, radiotherapy did not prove to be statistically relevant. It is likely that the survival rate of 39% was due to the high number of patients with metastasis (52%) and because the samples were mostly of tongue and mouth floor diseases (82%), which are the hardest to control. CONCLUSION: Neck metastases and diseased margins of oral cavity carcinomas are the prognostic factors that can most impact the survival rate.

Cisto cervical: maligno ou benigno? / Cervical cyst: malignant or benign?

Introdução: o carcinoma papilífero da tireóide pode apresentar-se a partir de uma metástase cervical. A presença de metástase cística cervical pode ser confundida com lesão benigna e postergar o tratamento adequado do carcinoma papilífero. Relato de caso: esse fato ocorreu com o caso apresentado o que nos trouxe ensinamentos. Trata-se de uma paciente jovem com lesão cervical cística há quatro anos, com ultra-sonografia compatível com lesão benigna. O exame histopatológico pós-operatório diagnosticou metástase de carcinoma papilífero de tireóide. Em nova ultrasonografia, duas imagens nodulares menores que 1cm foram observadas na glândula tireóide. Discussão: a dificuldade de diagnóstico clínico, por imagem e por punção aspirativa por agulha fina das lesões císticas pode postergar o diagnóstico e, com isso, o tratamento. O caso aqui apresentado nos alerta de que não devemos aceitar ultra-sonografia cervical que não contenha o estudo da glâdula tireóide, principalmente quando forem formações que possam sifnificar metástases.

Introduction: the thyroi papillary carcinoma can present itself as cervical metastasis. The presence of cystic cervical metastasis can be confused with benign lesions and delay the treatment of papillary carcinoma. Case report: it occurred in the present case. We are reporting a cse of a young female patient with a cystic cervical lesion for four years with ultrasonography (US) diagnostic compatible to a benign lesion. The patient underwent surgical resection and the histopathological analysis diagnosed metastasis of thyroid papillary carcinoma. Another US identified two nodes smaller than 1cm in the thyroid gland. Discussion: the difficulty of clinical and radiological diagnosis and the limitation of fine needle aspiration cytology of the cervical cystic lesions can delay the diagnosis and treatment. The cervical US without study of the thyroid cannot be accepted, specially when there is the possibility of a cervical metasasis.