Caracterización clínico-epidemiológica de pacientes con enfermedad hepática esteatósica asociada a disfunción metabólica previa al trasplante en un hospital de cuarto nivel / Clinical-epidemiological characterization of patients with steatotic liver disease associated with metabolic dysfunction prior to transplantation in a fourth level hospital

Introducción. La enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD) se ha convertido en la enfermedad hepática crónica más frecuente en los países occidentales, causando un aumento en los costos y en la ocupación hospitalaria. La caracterización integral previa al trasplante hepático en pacientes con MASLD es una gran interrogante, especialmente en nuestro medio. El objetivo del presente estudio fue realizar la caracterización clínico-epidemiológica de pacientes trasplantados por cirrosis hepática (CH) descompensada o carcinoma hepatocelular (CHC) asociado a MASLD. Metodología. Se desarrolló un estudio observacional retrospectivo, descriptivo, de corte transversal en el Servicio de Hepatología del Hospital Pablo Tobón Uribe en Medellín, Colombia. Se incluyeron pacientes mayores de 17 años, con diagnóstico de CH o de CHC asociado a MASLD que fueron trasplantados entre los años 2004 a 2017. Resultados. Se encontraron 84 pacientes que fueron trasplantados con esas características. La edad promedio de los pacientes fue de 59±10,5 con una mayor proporción significativa de hombres sobre mujeres, llegando casi al 70 %. Con relación a las comorbilidades, se encontró que el sobrepeso/obesidad, la hipertensión arterial y la diabetes mellitus tipo 2 fueron un hallazgo en el 44,1 %, 33,3 % y 33,3 %, respectivamente. Por otro lado, el 14,5 %, el 33,7 % y el 51,8 % presentaron un Child-Pugh A, B y C, respectivamente. La media del puntaje MELD fue de 18,9±6,26. Con respecto a las complicaciones de la cirrosis, el 77,4 % de los pacientes presentó ascitis, el 61,9 % encefalopatía hepática, el 36,9 % hemorragia del tracto digestivo superior y el 29,8 % peritonitis bacteriana espontánea. Conclusión. Los resultados expuestos mostraron nuestra experiencia en trasplante hepático en pacientes con CH y CHC asociado a MASLD. Se debe realizar una evaluación multidisciplinaria antes y después del trasplante en estos pacientes, haciendo especial énfasis en el manejo de la disfunción metabólica y sus componentes, entre los que se destacan la obesidad y la diabetes mellitus.

Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most frequent chronic liver disease in Western countries, causing increased costs and hospital occupancy. The comprehensive pre-transplant characterization in patients with MASLD is a major question, especially in our setting. The aim of the present study was to perform the clinical-epidemiological characterization of transplanted patients with decompensated liver cirrhosis (LC) or hepatocellular carcinoma (HCC) associated with MASLD. Methodology. A retrospective, descriptive, cross-sectional observational study was carried out in the Hepatology Department of the Pablo Tobón Uribe Hospital in Medellin, Colombia. Patients over 17 years of age, with a diagnosis of LC or HCC associated with MASLD who were transplanted between 2004 and 2017 were included. Results. We found 84 patients who were transplanted with these characteristics. The mean age of the patients was 59±10.5 with a significantly higher proportion of men over women, reaching almost 70%. Regarding comorbidities, overweight/obesity, arterial hypertension, and type 2 diabetes mellitus were found in 44.1%, 33.3%, and 33.3%, respectively. On the other hand, 14.5%, 33.7%, and 51.8% had Child-Pugh A, B, and C, respectively. The mean MELD score was 18.9±6.26. Regarding complications of cirrhosis, 77.4% of patients developed ascites, 61.9% hepatic encephalopathy, 36.9% upper gastrointestinal tract hemorrhage, and 29.8% spontaneous bacterial peritonitis. Conclusion. The above results showed our experience of liver transplantation in patients with LC and HCC associated with MASLD. A multidisciplinary evaluation should be performed before and after transplantation in these patients, with special emphasis on the management of metabolic dysfunction and its components, including obesity and diabetes mellitus.

Carcinoma de células escamosas y el rol discutido de la irritación mecánica crónica: informe de un caso / Squamous oral cell carcinoma and the discussed role of chronic mechanical irritation: report of a case

Objetivo: Describir el desarrollo de un carcinoma oral de células escamosas, en el que la irritación mecánica crónica aparenta tomar un rol protagonista en la carcinogénesis. Caso clínico: Un paciente de 41 años de edad, argen- tino, con antecedentes de fisura labio alvéolo palatina, diabe- tes mellitus, convulsiones, consumo de cocaína y marihuana, enolismo crónico y tabaquismo, acude al Servicio de Odonto- logía del Hospital Central de Mendoza para la evaluación de una úlcera dolorosa en el dorso de su lengua, de varias sema- nas de evolución, en íntima relación con un primer premolar superior derecho y una pieza supernumeraria. Se realizó una biopsia y de la anatomía patológica resultó el diagnóstico de carcinoma oral de células escamosas. Se ofreció al paciente posibles tratamientos que rechazó, por lo que se inició terapia paliativa y sintomática. Al avanzar su mal estado general, fa- lleció por complicaciones relacionadas a la deglución. Si bien no está definido el rol de la irritación mecánica crónica en la etiología de la carcinogénesis, ejerce un efecto promotor del daño causado por el tabaco y el alcohol. Si bien el paciente era fumador y bebía alcohol, se puede observar que desarrolló un carcinoma de células escamosas en evidente relación a un trauma crónico, ya que la lesión en la cara dorsal de lengua está en íntimo contacto con el factor irritante. Aun así, la evi- dencia actual disponible es limitada y discute el protagonismo del trauma crónico por lo que se necesitan más estudios para evaluar y definir la posible relación causal de la irritación me- cánica crónica en la carcinogénesis (AU)

Aim: To describe the development of an oral squamous cell carcinoma, in which chronic mechanical irritation ap- pears to play a significant role in carcinogenesis. Clinical case: A 41-year-old patient, from Argenti- na, with a history of cleft lip and palate, diabetes mellitus, seizures, cocaine and cannabis use, chronic alcoholism and smoking, comes to the Dentistry Service of the Central Hospi- tal for the evaluation of a painful ulcer on the dorsum of the tongue, which had been developing for several weeks, in close relation to an upper right first premolar and a supernumerary tooth. A biopsy was performed, and the pathological anatomy resulted in the diagnosis of oral squamous cell carcinoma. Possible treatments were offered to the patient, which he re- jected, so palliative and symptomatic therapy was initiated instead. As his poor general condition progressed, he died due to complications related to swallowing. Although the role of chronic mechanical irritation in the development of carcino- genesis is not yet fully defined, it has been shown to have a promoting effect on the damage caused by tobacco and alco- hol. Although the patient was a smoker and drank alcohol, it can be observed that he developed a squamous cell carcinoma in obvious relation to a chronic trauma, since the lesion devel- ops on the dorsal face of the tongue in close contact with the irritant factor. Still, the current evidence available is limited and discusses the role of chronic trauma, so more studies are needed to evaluate and define the possible causal relation- ship of chronic mechanical irritation in the development of carcinogenesis (AU)

Hiperplasia pseudoepiteliomatosa: carcinoma escamocelular versus paracoccidioidomicosis oral, un caso con mirada dermatológica / Pseudoepitheliomatous hyperplasia: Squamous cell carcinoma versus oral paracoccidioidomycosis, a case from a dermatological perspective

La paracoccidioidomicosis es una micosis sistémica endémica en Latinoamérica. La presentación más frecuente compromete crónicamente los pulmones, la piel y las mucosas. Al inicio, este paciente presentó, por varios años, una lesión única en la mucosa oral que, en ausencia de otros síntomas, se relacionó con una neoplasia maligna, específicamente con un carcinoma escamocelular. La diferenciación entre los dos diagnósticos se hace mediante un examen directo, un estudio histopatológico y cultivos iniciales y subsecuentes. Sin embargo, tales estudios no fueron concluyentes. Después de varias consultas y pruebas, con los resultados del examen directo, la inmunodifusión y la PCR en tiempo real se confirmó el diagnóstico de paracoccidioidomicosis crónica multifocal. Este caso alerta sobre la ausencia de sospecha clínica de micosis endémicas, dada la presencia de lesiones mucocutaneas que pueden ser producidas por hongos como Paracoccidioides spp, y la importancia de considerarlas entre los diagnósticos diferenciales.

Paracoccidioidomycosis is a systemic mycosis endemic in Latin America. The most frequent form involves a chronic compromise of the lungs, skin, and mucosa. The patient started with a single oral lesion that lasted for several years. The absence of other symptoms pointed out a possible malignant neoplasm, specifically a squamous cell carcinoma. Differentiation between both diagnoses-fungal infection and carcinoma-depends on the results of the direct examination, the histopathological study, and the initial and subsequent cultures. However, in this case, those findings were not conclusive. The coexistence of both diagnoses is frequent and increases the diagnostic challenge. After several consultations and tests, direct examination, immunodiffusion and real-time PCR findings the multifocal chronic paracoccidioidomycosis diagnosis was confirmed. This case warns about a systematical absence of clinical suspicion of endemic mycoses before the appereance of mucocutaneous lesions, which can be produced by fungi like Paracoccidioides spp, and the importance of considering those mycoses among the differential diagnoses.

Marjolin ulcer: the importance of early diagnosis and excision / Úlcera de Marjolin: a importância do diagnóstico e excisão precoces

Introduction: Marjolin's ulcer is a rare disease characterized by the malignancy of chronic wounds that present healing disorders, often due to chronic irritation and repetitive trauma in this area. The diagnosis is made mainly through clinical history and histopathological examination. The differential diagnoses of other diseases that course with ulcers must always be researched and ruled out. Method: The present work presents a bibliographic review to elucidate the subject's relevance for medical students, physicians and nurses, to assist in early diagnosis. Results: Nine observational studies were selected to compose the discussion. Conclusion: The most effective treatment for this condition is surgery, and lymph node dissection is suggested in some cases. Chemotherapy has not shown satisfactory results, while radiotherapy is used in selected cases. Given the rapid evolution, tissue damage, and worse prognosis, diagnosis, and excision should be performed early for a better clinical outcome.

Introdução: A úlcera de Marjolin é uma doença rara, caracterizada pela malignização de feridas crônicas que apresentaram distúrbios cicatriciais, muitas vezes devido à irritação crônica e a traumas repetitivos nesta área. O diagnóstico é realizado sobretudo através da história clínica e de exame histopatológico. Os diagnósticos diferenciais de outras doenças que cursam com úlceras devem sempre ser pesquisados e afastados. Método: O presente trabalho apresenta uma revisão bibliográfica, a fim de elucidar a relevância do tema para acadêmicos de medicina, médicos e enfermeiros, com o propósito de auxiliar no diagnóstico precoce. Resultados: Foram selecionados 9 estudos observacionais para compor a discussão. Conclusão: O tratamento mais eficaz desta condição é o cirúrgico, e o esvaziamento linfonodal é sugerido em alguns casos. A quimioterapia não demonstrou resultados satisfatórios, enquanto a radioterapia é utilizada em casos selecionados. O diagnóstico e a excisão devem ser feitos precocemente para melhor desfecho clínico, visto a rapidez da evolução, o prejuízo tecidual e pior prognóstico.

Hepatosplenic schistosomiasis-associated chronic portal vein thrombosis: risk factor for hepatocellular carcinoma? / Esquistossomose hepatosplênica associada à trombose crônica da veia porta: fator de risco para o carcinoma hepatocelular?

ABSTRACT BACKGROUND: Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis. AIMS: To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up. METHODS: A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021. RESULTS: A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5-31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before. CONCLUSIONS: The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients.

RESUMO RACIONAL: A esquistossomose hepatoesplênica é uma doença endêmica prevalente em países tropicais e está associada a uma alta incidência de trombose da veia porta. Alterações inflamatórias causadas tanto pela infecção parasitária quanto pela trombose portal podem levar ao desenvolvimento de doença hepática crônica com potencial carcinogênico. OBJETIVOS: Avaliar a incidência de trombose da veia porta e carcinoma hepatocelular em pacientes com esquistossomose durante um seguimento de longo prazo. MÉTODOS: Foi realizado estudo retrospectivo envolvendo pacientes com esquistossomose acompanhados em nossa instituição entre 1990 e 2021. RESULTADOS: Um total de 126 pacientes com esquistossomose foram avaliados no estudo. O tempo médio de acompanhamento foi de 16 anos (variando de 5 a 31). Do total, 73 (57,9%) pacientes apresentaram trombose da veia porta durante o seguimento e seis (8,1%) deles foram diagnosticados com carcinoma hepatocelular, todos com trombose da veia porta diagnosticada há mais de 10 anos. CONCLUSÕES: A incidência de carcinoma hepatocelular em pacientes com esquistossomose e trombose da veia porta crônica destaca a importância de um acompanhamento sistemático de longo prazo nesse grupo de pacientes.

Experiencia de downstaging versus criterios de Milán para trasplante hepático por carcinoma hepatocelular en una cohorte prospectiva / Experience with downstaging versus Milan criteria for liver transplantation in patients with hepatocellular carcinoma in a prospective cohort

Introducción. El acceso al trasplante hepático (TH) en pacientes con carcinoma hepatocelular (CHC) se basa en la aplicación de criterios morfológicos rigurosos estipulados desde 1996, co-nocidos como criterios de Milán. Una de las estrategias descritas para expandir estos criterios se conoce como downstaging (reducción del estadiaje tumoral mediante terapias locorregionales). El objetivo de este estudio fue describir el comportamiento postrasplante de pacientes con CHC que ingresaron dentro de los parámetros de Milán, comparado con el de aquellos pacientes llevados a terapia de downstaging en un centro colombiano. Metodología. Se incluyeron pacientes adultos con cirrosis hepática (CH) y CHC que fueron llevados a TH en el Hospital Pablo Tobón Uribe, entre julio de 2012 a septiembre de 2021. Como desenlace principal se definió recurrencia y tiempo de recurrencia de la enfermedad tumoral, muerte por todas las causas y tiempo al fallecimiento. Se evaluaron las características sociodemográficas y clínicas de cada grupo. Se incluyeron scores pronósticos de recurrencia de la enfermedad tumoral. Resultados. Se trasplantaron 68 pacientes con CH y CHC, 50 (73,5 %) eran hombres y la edad promedio fue 59 años; 51 pacientes (75 %) cumplían con los criterios de Milán y 17 (25 %) fueron llevados a terapia de downstaging previo al TH. No hubo diferencias significativas en la supervivencia global y supervivencia libre de trasplante entre los dos grupos evaluados, p=0,479 y p=0,385, respectivamente. Tampoco hubo diferencia significativa en la recurrencia de la enfermedad tumoral entre ambos grupos (p=0,81). En total hubo 7 casos de recurrencia tumoral (10,2 %) y 11 casos de muerte (16,2 %). Conclusiones. No se encontraron diferencias significativas en recurrencia y mortalidad entre los pacientes que cumplían los criterios de Milán y los trasplantados luego de la terapia de downstaging, en un tiempo de se-guimiento de 53 meses hasta el último control posterior al trasplante hepático. Esta sería la primera evaluación prospectiva de un protocolo de downstaging para CHC en Colombia.

Introduction. Access to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) is based on the application of rigorous morphological criteria stipulated since 1996, known as the Milan criteria. One of the strategies described to expand these criteria is known as downstaging (tu-mor staging reduction through locoregional therapies). The objective of this study was to describe the post-transplant performance of patients with HCC who were admitted within the Milan parameters, compared with those of patients taken to downstaging therapy, in a Colombian center. Methodolo-gy. Adult patients with cirrhosis and HCC that received LT between July 2012 and September 2021 at the Pablo Tobón Uribe Hospital were included. The main outcome was defined as recurrence and time to recurrence of the tumor disease, death from all causes, and time to death. The socio-demographic and clinical characteristics of each group were evaluated. Tumor disease recurrence prognostic scores were included. Results. Sixty-eight patients with cirrhosis and HCC received LT in the time frame, 50 (73.5%) were men and the mean age was 59 years. Fifty-one patients were trans-planted (75%) fulfilling Milan criteria, and 17 (25%) patients received downstaging therapies before LT. There were no significant differences in overall survival and transplant-free survival between the two groups, p=0.479 and p=0.385, respectively. There was also no significant difference in the recurrence of the tumor disease between both groups (p=0.81). In total there were 7 tumoral recurrences (10.2%) and 11 deaths (16.2%). Conclusions. There were no differences in recurrence and survival between patients transplanted fulfilling Milan criteria and those receiving downstaging therapies, following a mean time of 53 months after LT. This is the first prospective evaluation of the downstaging protocol in Colombia.

Carcinoma espinocelular sobre cicatriz de fístula arteriovenosa: relato de caso / Squamous cell carcinoma on an arteriovenous fistula scar: case report

Resumo A fístula arteriovenosa (FAV) é o principal acesso para hemodiálise devido à sua patência superior e menores índices de complicação quando comparada aos demais acessos para hemodiálise. Relatamos o caso de uma paciente do sexo feminino, de 69 anos, com doença renal crônica dialítica secundária a nefroesclerose hipertensiva com FAV radio-cefálica no membro superior esquerdo realizada há 9 anos. Há 2 anos, foi submetida a transplante renal e fazia uso de imunossupressores. Evoluiu com aparecimento de lesão crostosa em antebraço esquerdo há 3 meses, foi submetida a biópsia excisional, e foi evidenciado carcinoma espinocelular bem diferenciado e superficialmente invasivo, com margens cirúrgicas laterais e profundas livres de neoplasia. No seguimento de 1 ano, a paciente não apresentava sinais de recidiva neoplásica.

Abstract The main type of access used for hemodialysis is the arteriovenous fistula (AVF) because it offers superior patency and lower complication rates when compared to other hemodialysis accesses. We report the case of a 69-year-old female patient with chronic kidney disease on dialysis secondary to hypertensive nephrosclerosis with a radiocephalic AVF in the left upper limb created 9 years previously. Two years previously, she had undergone a kidney transplant and was taking immunosuppressants. A crusted lesion developed on her left forearm with onset 3 months before presentation and she underwent an excisional biopsy that revealed a well-differentiated and superficially invasive squamous cell carcinoma, with lateral and deep surgical margins free from neoplasia. At 1-year follow-up, the patient showed no signs of neoplastic recurrence.

Cáncer de cavidad oral en pacientes del departamento de cirugía de cabeza y cuello - cátedra y servicio de otorrinolaringología del Hospital de Clínicas - Universidad Nacional de Asunción / Oral cavity cancer in patients from the department of head and neck surgery - chair and otorhinolaryngology service of the Hospital de Clínicas - National University of Asunción

La cavidad oral está continuamente expuesta a carcinógenos inhalados e ingeridos (tabaco y alcohol principalmente), y por lo tanto es el sitio más común para el origen de neoplasias en la región de la cabeza y el cuello.Para esta investigación, se realizó un estudio observacional descriptivo, de corte transversal, retrospectivo, de muestreo no probabilístico de casos consecutivos. Se incluyó a pacientes mayores de edad, con diagnóstico clínico y anatomopatológico de cáncer de cavidad oral.Así, se incluyó una serie de 17 casos de carcinoma escamocelular oral, 13 hombres (76 %) y 4 mujeres (24 %), donde la edad de los individuos osciló entre 32 y 73 años.El 65 % de los pacientes era fumador y el 71% refirió consumo de bebidas alcohólicas.La lengua fue la localización tumoral más frecuente, con el 71% de las personas que se encontraba en estadio IV, y con moderado grado de diferenciación histológica. Como conclusión, se determinó que la mayor parte de los pacientes de este estudio correspondían al sexo masculino de 50 a 70 años. Un alto porcentaje de los pacientes refería el hábito tabáquico, y mayor aún el consumo de alcohol. El subsitio más frecuentemente afectado es la lengua, en estadios avanzados y moderado grado de diferenciación.

INTRODUCTION: The oral cavity is continuously exposed to inhaled and ingested carcinogens (mainly tobacco and alcohol), and therefore it is the most common site for the origin of neoplasms in the head and neck region. METHODS: A descriptive, retrospective, observational study of non-probabilistic sampling of consecutive cases was carried out. Adult patients with a clinical and pathological diagnosis of oral cavity cancer were included. RESULTS: A series of 17 cases of oral squamous cell carcinoma was included, 13 men (76%) and 4 women (24%). The age of the individuals ranged between 32 and 73 years.65% of the patients were smokers, and 71% reported consumption of alcoholic beverages.The tongue was the most frequent tumor location, 71% were in stage IV, and with a moderate degree of histological differentiation. CONCLUSION: Most of the patients in this study were males between 50 and 70 years of age. A high percentage of patients reported smoking, and an even higher percentage of alcohol consumption. The most frequently affected subsite is the tongue, in advanced stages and a moderate degree of differentiation.

Asociación entre tiroiditis linfocítica crónica y carcinoma papilar de tiroides: Revisión sistemática y metaanálisis de estudios en especímenes quirúrgicos / Association between chronic lymphocityc thyroiditis and papillary thyroid carcinoma: Systematic review and meta-analysis of studieson surgical specimens

Introducción. Existen resultados inconsistentes con relación al planteamiento de la hipótesis que sugiere una mayor probabilidad de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos con cambios compatibles con tiroiditis linfocítica crónica. En los metaanálisis existentes se han incluido estudios no comparables metodológicamente y no se proponen claras fuentes de sesgo, justificación para la realización del presente metaanálisis. Métodos. Se realizó una búsqueda bibliográfica en Pubmed y Embase. Fueron obtenidos estudios retrospectivos donde se comparaba la prevalencia de carcinoma papilar de tiroides en especímenes con y sin cambios por tiroiditis linfocítica crónica. La evidencia recolectada fue sintetizada estadísticamente. Resultados. Un total de 22 artículos fueron incluidos. La población estuvo conformada por 63.548 especímenes. El OR combinado fue 1,81 (IC95%: 1,51-2,21). Hubo heterogeneidad entre la distribución de las razones de oportunidad entre los estudios (I2= 91 %; p>0,00001). La forma del gráfico en embudo de los estudios incluidos en el análisis parece estar simétrica, lo que indica la ausencia del sesgo atribuible a los estudios pequeños. Conclusiones. La literatura actual sugiere que existe un mayor riesgo de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos en los que se observan cambios compatibles con tiroiditis linfocítica crónica; sin embargo, existen fuentes de sesgo que no será posible controlar en estudios retrospectivos, por lo que recomendamos estudiar la hipótesis que sugiere una mayor probabilidad de diagnosticar un carcinoma papilar de tiroides en especímenes con cambios compatibles con tiroiditis linfocítica crónica mediante metodologías prospectivas

Introduction. Inconsistent results exist in the literature regarding the hypothesis statement suggesting an increased likelihood of documenting papillary thyroid carcinoma (PTC) in surgical specimens with changes compatible with chronic lymphocytic thyroiditis. Existing meta-analyses have included studies that are not methodologically comparable and do not propose clear sources of bias, thus, this is justification for the present meta-analysis. Methods. A literature search in Pubmed and Embase was performed from January 1, 1950 to December 31, 2020. Retrospective studies comparing the prevalence of papillary thyroid carcinoma in specimens with and without chronic lymphocytic thyroiditis changes were obtained. The collected evidence was statistically analyzed. Results. A total of 22 articles were included. The study population consisted of 63,548 surgical specimens. The pooled OR, based on the studies, was 1.81 (95% CI: 1.51-2.21). There was heterogeneity between the distribution of prevalence ratios and opportunity ratios across studies (I²= 91%; p>0.00001). The funnel plot shape of the studies included in the analysis appears to be symmetrical, indicating the absence of bias attributable to small studies. Conclusions. The current literature suggests that there is an increased risk of documenting papillary thyroid carcinoma in surgical specimens in which chronic lymphocytic thyroiditis-compatible changes are observed; however, there are sources of bias that will not be possible to control for in retrospective studies, so we recommend studying the hypothesis suggesting an increased likelihood of diagnosing PTC in specimens with chronic lymphocytic thyroiditis-compatible changes using prospective methodologies

El pH salival como marcador biológico en pacientes diagnosticados con carcinoma epidermoide oral de Guantánamo / Salivary pH as diagnostic biomarker in patients diagnosed with oral squamous cells carcinoma in Guantanamo / pH salivar como marcador biológico em pacientes diagnosticados com carcinoma epidermóide oral de Guantánamo

RESUMEN Introducción: El cáncer bucal constituye un problema de salud de connotación mundial. Objetivo: Comparar las variaciones del pH salival entre pacientes con carcinoma epidermoide recién diagnosticados, después del tratamiento oncoespecífico y sujetos aparentemente sanos de la provincia Guantánamo, Cuba, en el período noviembre 2019- enero 2022. Método: Se realizó un estudio descriptivo, comparativo, transversal, en pacientes ambulatorios de la consulta de Cirugía Maxilofacial del Hospital General Docente "Dr. Agostinho Neto". El grupo de estudio estuvo conformado por 200 pacientes divididos en 3 subgrupos: subgrupo I (50 pacientes recién diagnosticados con carcinoma epidermoide oral, con diagnóstico concomitante de caries dental y periodontitis crónica del adulto); subgrupo II (50 pacientes con la referida patología después de tratamiento oncoespecífico, tratados por las enfermedades bucales antes citadas) y subgrupo III (100 pacientes controles aparentemente sanos). Se estudiaron las variables: edad, sexo, tipo de dieta y pH salival. Resultados: La edad media fue de 59,8 años, 70 % fueron hombres. Se asoció la dieta consumida y cada subgrupo (p=0,001). El pH salival de los pacientes con carcinoma epidermoide recién diagnosticados afectados por ambas enfermedades bucales fue ácido (6,25±0,37) en comparación a los otros subgrupos. El 98,6 % de los pacientes con pH salival ácido presentaron una dieta usual a base de carbohidratos y grasas (p=0,000). Conclusiones: Se evidenció que el pH salival de los pacientes con carcinoma epidermoide recién diagnosticados fue ácido en comparación a los otros subgrupos, por lo que este parámetro puede usarse como un marcador biológico de la enfermedad.

ABSTRACT Introduction: Oral cancer is a common health problem worldwide. Objective: Compare the salivary pH range changes among patients diagnosed recently with oral squamous cells carcinoma after receiving oncospecific treatment and subjects apparently healthy, Guantanamo, Cuba, period time November 2019 -January 2022. Method: A descriptive, comparative, cross-sectional study was carried out in outpatients of the Maxillofacial Surgery Consultation room at the Hospital General Docente "Dr. Agostinho Neto". The study group consisted of 200 patients divided into 3 subgroups: subgroup I (50 newly diagnosed patients with oral squamous cell carcinoma, with concomitant diagnosis of dental caries and chronic adult periodontitis); subgroup II (50 patients with the aforementioned pathology after oncospecific treatment, treated for the aforementioned oral diseases) and subgroup III (100 apparently healthy control patients). The following variables were studied: age, sex, type of diet and salivary pH. Results: Average age was 59.8 years, 70% were men. There was an association between the diet consumed and each subgroup (p= 0.001). The salivary pH of newly diagnosed squamous cell carcinoma patients affected by both oral diseases was acidic (6.25±0.37) compared to the other subgroups. The 98.6% of patients with acid salivary pH presented a usual diet based on carbohydrates and fats (p=0.000). Conclusions: It was shown that the salivary pH of newly diagnosed patients with squamous cell carcinoma was acidic compared to the other subgroups. Therefore, this parameter can be used as a biological marker of the disease.

RESUMO Introdução: O câncer bucal é um problema de saúde global. Objetivo: Comparar as variações do pH salivar entre pacientes com carcinoma espinocelular recém-diagnosticado, após tratamento oncoespecífico, e indivíduos aparentemente saudáveis da província de Guantánamo, Cuba, no período de novembro de 2019 a janeiro de 2022. Método: Estudo descritivo, comparativo, cruzado seccional, em pacientes ambulatoriais da consulta de Cirurgia Bucomaxilofacial do Hospital General Docente "Dr. Agostinho Neto". O grupo de estudo foi composto por 200 pacientes divididos em 3 subgrupos: subgrupo I (50 pacientes recém-diagnosticados com carcinoma espinocelular oral, com diagnóstico concomitante de cárie dentária e periodontite crônica do adulto); subgrupo II (50 pacientes com a patologia supracitada após tratamento oncoespecífico, tratados para as doenças bucais supracitadas) e subgrupo III (100 pacientes controles aparentemente saudáveis). As variáveis estudadas foram: idade, sexo, tipo de dieta e pH salivar. Resultados: A média de idade foi de 59,8 anos, 70% eram homens. A dieta consumida e cada subgrupo foram associados (p=0,001). O pH salivar de pacientes recém-diagnosticados com carcinoma espinocelular afetados por ambas as doenças bucais foi ácido (6,25±0,37) em comparação com os outros subgrupos. 98,6% dos pacientes com pH salivar ácido apresentaram dieta habitual baseada em carboidratos e gorduras (p=0,000). Conclusões: Evidenciou-se que o pH salivar dos pacientes com carcinoma espinocelular recém-diagnosticado foi ácido em relação aos demais subgrupos. Portanto, esse parâmetro pode ser utilizado como marcador biológico da doença.

Hallazgos genitourinarios en mujeres con tumores ováricos / Genito-urinary findings in women with ovarian tumors

Los tumores de ovario son los trastornos ginecológicos más comunes. Los tumores de ovario son el tercer tumor más común en las mujeres. Los tumores de ovario a veces son asintomáticos y tienen síntomas no específicos, lo que hace que la mayoría de los casos sean difíciles de detectar temprano. El objetivo de este estudio fue investigar las características genitourinarias del tumor ovárico en un estudio hospitalario. Se realizó un estudio observacional en Bagdad, Iraq, entre septiembre de 2018 y febrero de 2021. Las mujeres diagnosticadas con tumores ovarios a los 18 años de edad o más. Un total de cincuenta mujeres que se inscribieron en nuestro hospital. Datos clínicos y patológicos recopilados y analizados. Los datos sobre comorbilidades y resultados fueron aprobados y diagnosticados por un equipo completo de médicos ginecológicos y urológicos multidisciplinarios. La incidencia general de tumores ováricos fue 70% maligna y 30% benigna. El estudio mostró que la mayor parte del grupo de edad de tumores ováricos era superior a 55 años (62%). La mitad de los pacientes eran nuliparidades. El nivel educativo era principalmente de bajo nivel en analfabeto (20%), primario (24%), secundario (36%) en comparación con el alto nivel. Las mujeres usaron anticoncepción en 52%. La historia familiar informó en el 18% de las mujeres. El tipo histopatológico más común era el carcinoma seroso ovárico 15 (30%). Las etapas regionales eran comunes en el 50% de los pacientes. Tumores de bajo grado en 32%, intermedio en 36%y alto en 32%. Casi, el 80% de las mujeres se sometieron a TAH. Alrededor del 60% de los pacientes recibieron quimioterapia. Los resultados de salud genitourinaria adversos a largo plazo incluyeron nefritis (6%), insuficiencia renal aguda (16%), enfermedad renal crónica (18%), infección urinaria (38%), cálculo (16%), hidronefrosis (20%), Obstrucción de la vejiga (2%), estenosis ureteral (12%), retención de orina (8%), incontinencia de orina (12%), hematuria (22%), PID (14%), adhesión de órganos (8%), cervicitis (2 %), Endometriosis (2%), quiste (6%), trastornos menstruales (24%), infertilidad (2%) y dolor menopáusica (32%). En conclusión, el cáncer de ovario representa el tercer tipo de cáncer ginecológico más común. Era más común en mujeres mayores de cinco décadas. El tipo histopatológico más común es el carcinoma seroso ovárico. Observamos que los sobrevivientes de cáncer de ovario experimentaron mayores riesgos de varias enfermedades genitourinarias. Comprender los escenarios de la morbilidad múltiple para los tumores ováricos es de vital importancia para mejorar la atención clínica después del diagnóstico.

Ovarian tumors are the most common gynecological disorders. Ovarian tumors are the third most common tumor in women. Ovarian tumors are sometimes asymptomatic and have non-specific symptoms, making most cases difficult to detect early. The aim of this study was to investigate genitourinary features of ovarian tumor in a hospital-based study. An observational study was conducted in Baghdad, Iraq, between September 2018 and February 2021. Women diagnosed with ovarian tumors at 18 years of age or older. A total of Fifty women who enrolled in our hospital. Clinical and pathological data collected and analyzed. Data about comorbidities and outcomes were approved and diagnosed by full team of multidisciplinary gynecological and urological doctors were recorded. Overall incidence of ovarian tumors was 70% malignant and 30% benign. The study showed that the most age group of ovarian tumors was above 55 years (62%). Half of patients were nulliparities. Educational level was mostly of low level in illiterate (20%), primary (24%), secondary (36%) compared to high level. Women used contraception in 52%. The family history reported in 18% of women. The most common histopathological type was ovarian serous carcinoma 15(30%). Regional stages were common in 50% of patients. Low grade tumors in 32%, intermediate in 36% and high in 32%. Almost, 80% of women underwent TAH. About 60% of patients received chemotherapy. The long-term adverse genitourinary health outcomes correlated included Nephritis (6%), Acute renal failure (16%), Chronic kidney disease (18%), UTI (38%), Calculus (16%), Hydronephrosis (20%), Bladder obstruction (2%), Ureteric stenosis (12%), Urine retention (8%), Urine incontinence (12%), Hematuria (22%), PID (14%), Organ adhesion (8%), Cervicitis (2%), Endometriosis (2%), Cyst (6%), Menstrual disorders (24%), Infertility (2%), and Menopausal pain (32%). In conclusion, ovarian cancer represents the third most common gynecologic cancer type. It was more common in women aged above five decades. The most common histopathological type is ovarian serous carcinoma. We observed that ovarian cancer survivors experienced increased risks of various genitourinary diseases. Understanding the multi-morbidity scenarios for ovarian tumors is of vital importance to improve clinical care after diagnosis.

Hepatocellular carcinoma: A real-life experience in a specialized center in Bogotá, Colombia / Hepatocarcinoma: experiencia de la vida real en un centro especializado de Bogotá, Colombia

Abstract Introduction: Hepatocellular carcinoma (HCC) is the most frequent malignant primary liver tumor globally. In 2018, it ranked sixth and represented the fourth cause of death from cancer; the five-year overall survival is 18 %. Most cases of HCC develop in patients with cirrhosis of any etiology, especially because of hepatitis B and C viruses, alcohol, and recently nonalcoholic steatohepatitis (NASH). Aim: To analyze the clinical characteristics, diagnostic methods, treatments, prognostic variables, and survival. Materials and methods: This retrospective descriptive study was conducted on a cohort of patients diagnosed with cirrhosis and treated between January 2011 and December 2020 at a health care center in Bogotá. The diagnosis of HCC was confirmed radiologically or by biopsy. We analyzed the information descriptively with absolute frequency measures in the case of categorical variables. For continuous variables, the information was summarized with measures of central tendency (mean or median) and their relevant measures of dispersion. Results: We included 152 patients diagnosed with HCC, with a mean age of 69.4 years; 51.3 % were men. The leading cause of HCC was nonalcoholic fatty liver disease (NAFLD), which accounted for almost a third of cases (32 %); other causes were alcohol (15 %) and hepatitis C virus (14 %). The median manifestation of the tumor was two nodules with a size close to 4 cm. Besides, 35 % of patients had a BCLC (Barcelona Clinic Liver Cancer) stage with curative options, and 25 % received curative treatment options. The first-line systemic therapy used in this cohort was sorafenib®, used in 35 patients (33.7 %). Survival curves showed that women, Child-Pugh class A, and BCLC stage 0 had higher median survival. Multivariate analysis showed a higher risk of death for males (hazard ratio [HR]: 2.16; confidence interval [CI]: 1.24-3.76), Child-Pugh class B (HR: 2.14; CI 1.16-3.95), and Child-Pugh class C (HR: 7.52; CI 2.88-19.57). Conclusions: NAFLD is the leading cause of HCC in this cohort. A third of patients are diagnosed in early BCLC stages with a curative treatment option, and 25 % are treated with curative therapies. Sorafenib was the first-line therapy in advanced HCC. Overall survival after diagnosis of HCC remains low, being necessary to join forces in the follow-up of patients with cirrhosis to improve these outcomes.

Resumen Introducción: el hepatocarcinoma (HCC) es el tumor hepático primario maligno más frecuente en el mundo: en 2018 ocupó la sexta posición y representó la cuarta causa de muerte por cáncer; la supervivencia global a 5 años es del 18 %. La mayoría de los casos de HCC se desarrolla en pacientes con cirrosis de cualquier etiología, especialmente por virus de la hepatitis B y C, alcohol y, recientemente, por la esteatohepatitis no alcohólica (NASH). Objetivo: analizar las características clínicas, métodos de diagnóstico, tratamientos, variables pronósticas y supervivencia. Metodología: estudio descriptivo retrospectivo de una cohorte de pacientes con diagnóstico de cirrosis atendidos entre enero de 2011 y diciembre de 2020 en un centro de atención médica de Bogotá, con diagnóstico de HCC confirmado radiológicamente o por biopsia. La información se analizó de forma descriptiva con medidas de frecuencia absoluta en el caso de las variables categóricas; para las variables continuas se resumió la información con medidas de tendencia central (media o medianas) y su respectiva medida de dispersión. Resultados: se incluyeron 152 pacientes diagnosticados con HCC, con edad promedio de 69,4 años, 51,3 % eran hombres. La principal causa de HCC fue el hígado graso no alcohólico (NAFLD), que representó casi una tercera parte de los casos (32 %); otras causas fueron el alcohol (15 %) y el virus de la hepatitis C (14 %). La mediana de presentación del tumor fue de 2 nódulos con un tamaño cercano a 4 cm. El 35 % de los pacientes tenía un estadio BCLC (Barcelona Clinic Liver Cancer) con opciones curativas y el 25 % de los pacientes recibió opciones curativas de tratamiento. La terapia sistémica de primera línea utilizada en esta cohorte fue el sorafenib®, que se utilizó en 35 pacientes (33,7 %). Las curvas de supervivencia mostraron que las mujeres, el estadio Child-Pugh A y el estadio BCLC 0 presentaron mayores medianas de supervivencia. El análisis multivariado evidenció un mayor riesgo de muerte al ser hombre (Hazard ratio [HR]: 2,16; intervalo de confianza [IC]: 1,24 a 3,76), estar en los estadios Child-Pugh B (HR: 2,14; IC: 1,16 a 3,95) y Child-Pugh C (HR: 7,52; IC: 2,88 a 19,57). Conclusiones: el NAFLD es la principal causa de HCC en la presente cohorte, una tercera parte de los pacientes se diagnostica en estadios BCLC tempranos con opción curativa de tratamiento, y un 25 % se trata con terapias curativas. El sorafenib fue la terapia de primera línea en HCC avanzado. La supervivencia global luego del diagnóstico de HCC sigue siendo baja, y es necesario aunar esfuerzos en el seguimiento de los pacientes con cirrosis para mejorar estos resultados.

Análise do perfil clínico de pacientes portadores de neoplasia ocular escamosa atendidos em hospital referência de oculoplástica / Analysis of the clinical profile of patients with squamous ocular neoplasms attended at a reference hospital of oculoplastics

RESUMO Objetivo Analisar o perfil clínico de pacientes portadores de neoplasias escamosas da superfície ocular. Métodos Foram avaliados os principais fatores de risco envolvidos na gênese das neoplasias escamosas da superfície ocular, as características clínicas dos pacientes e os hábitos comportamentais associados. Foram incluídos neste trabalho de coorte histórica 80 pacientes com diagnóstico anatomopatológico de neoplasia escamosa da superfície ocular atendidos entre os anos de 2010 e 2020 em um hospital referência em oculoplástica e segmento anterior de Santa Catarina. Os dados clínicos e desfechos foram avaliados por meio da análise de prontuário e entrevista, sendo posteriormente tabulados no Excel e submetidos à analise estatística por meio do software Statistical Pakage for the Social Sciences, versão 16. Resultados Foi observado que 73,8% (n=59) eram do sexo masculino. A média de idade da amostra foi de 62 anos. Quanto ao fototipo de pele, de acordo com a escala de Fitzpatrick, constatou-se que a maioria apresentou os fototipos 1 e 2 (22; 27,5% e 44; 55%, respectivamente). Em relação à exposição ocupacional ao sol/radiação, 48% (n=60) apresentaram história de exposição ocupacional, sendo que, destes, 28 pacientes trabalhavam no setor de agricultura. Dos pacientes da amostra, 33 (41,2%) apresentavam histórico pessoal de neoplasias de pele, sendo que, destes, três apresentavam diagnóstico de xeroderma pigmentoso. Quanto ao hábito de uso de fatores de proteção solar, 61% (n=49) da amostra negou o hábito. Foi evidenciada associação estatisticamente significativa entre o hábito de usar fatores de proteção solar e histórico pessoal de neoplasias de pele. Em relação ao tipo de neoplasia escamosa, a maioria dos pacientes (72; 90%) apresentou diagnóstico anatomopatológico de carcinoma espinocelular ocular. Conclusão O perfil clínico epidemiológico dos pacientes portadores de neoplasias escamosas da superfície ocular neste estudo, predominantemente de carcinoma espinoceular ocular, foi de homens, idosos, de pele clara (fototipo 2) e com histórico importante de exposição aos raios solares ultravioleta A e B. Comorbidades imunodepressoras (HIV e transplante de órgão sólido) e doenças dermatológicas (albinismo e xeroderma pigmentoso) associaram-se ao aparecimento das neoplasias escamosas da superfície ocular em idade mais precoce. Em pacientes com histórico pessoal prévio de neoplasias de pele, foi evidenciado o hábito de uso de fatores de protetor solar mais presente em relação aos demais.

ABSTRACT Objective To analyze the clinical profile of patients with ocular surface squamous neoplasms (OSSN). Methods The main risk factors involved in the genesis of the ocular surface squamous neoplasms, the clinical features, and the behavioral habits associated were evaluated. This historical cohort study included 80 patients with anatomopathological diagnosis of OSSN who were treated between 2010-2020 at a reference hospital in oculoplastic and anterior segment in Santa Catarina. The clinical data and outcomes were evalated through the analysis of medical records and interviews, being later tabulated in Excel and analyzed using the SPSS 16 software. Results Regarding the clinical profile of the patients in the sample, 73.8% (n = 59) were male. The mean age of the sample was 62 years old. As for the skin phototype, according to the Fitzpatrick scale, most of the sample presented the phototype 1 and 2 (27.5% n = 22; and 55% n = 44 respectively). Regarding occupational exposure to the sun / radiation, 48% (n = 60) had history of occupational exposure, and of these, 28 patients worked in the agricultural area. Of the patients of the sample, 33 (41.2%) had a personal history of skin neoplasms, and of these, 3 had diagnosis of xeroderma pigmentosum. As for the habit of using sun protection factors, 61% (n = 49) of the sample denied the habit. A statistically significant association was evidenced between the habit of using sun protection factors and people's history of skin cancer. Regarding the type of squamous neoplasia, most patients in the 90% sample (n = 72) had an anatomopathological diagnosis of ocular squamous cell carcinoma. Conclusion The clinical epidemiological profile of patients with OSSN in this study, predominantly ocular squamous cell carcinoma, was men, elderly, fair-skinned (phototype 2) and with an important history of exposure to UVA and UVB rays. Immunosuppressive comorbidities (HIV, solid organ transplant) and dermatological diseases (albinism, xeroderma pigmentosum) are associated with the appearance of OSSN at an early age. In patients with a previous personal history of skin neoplasms, the habit of using sunscreen factors was more present than in the other patients.

Características y manejo del cáncer de mama precoz en mujeres añosas asistidas en la Unidad Docente Asistencial de Mastología del Hospital de Clínicas en el período 2011-2018 / Characteristics and management of early breast cancer in elderly women assisted in the Mastology Care Teaching Unit of the Hospital de Clínicas in the period 2011-2018 / Características e manejo do câncer de mama precoce em idosas atendidas na Unidade de Ensino de Mastologia do Hospital de Clínicas no período de 2011-2018

Introducción: Existen pocas pautas para el tratamiento del cáncer de mama (CM) en pacientes añosas, lo que puede conducir al sub o sobre tratamiento. Objetivo: Conocer las características, manejo y la evolución del CM precoz en mujeres añosas. Material y métodos: Estudio observacional, descriptivo, transversal. Se recolectaron datos relacionados con las características clínico-patológicas y la evolución de pacientes de 70 años o más tratadas por CM en el período comprendido entre el 1/1/ 2011 y el 31/12/ 2018, asistidas en el Hospital de Clínicas. Se utilizaron herramientas de estadística descriptiva y para calcular la sobrevida global (SVG) se utilizó el método de Kaplan-Meier. Resultados: se incluyeron 31 pacientes; la edad mediana al diagnóstico fue 76,8 años; las características clínico-patológicas fueron: carcinoma ductal: 71%; GH 1-2: 74,2%; estadio I: 54,8 %; sin metástasis axilares: 80,6 %; HER2-RE/RP+ 80,6%; HER2+ 16,7%, y triple negativas 3,2%. El 29% de las pacientes fueron diagnosticadas mediante tamizaje poblacional y el 74,2% recibieron tratamiento según pautas vigentes, mientras que el 38,7% fueron subtratadas y el 16,1% sobretratadas. La mediana de SVG fue de 98,7 meses. Conclusiones: Una minoría de las pacientes fue diagnosticada mediante tamizaje poblacional, el tipo histológico más frecuente fue el ductal y la prevalencia de los tumores HER2-RE/RP+ fue mayor que en las pacientes más jóvenes. La mayoría de las pacientes recibió tratamiento estandar.

Introduction: There are few guidelines for the treatment of breast cancer (BC) in older patients, which can lead to under- or over-treatment. Objective: To understand the characteristics, management and evolution of early BC in older women. Material and methods: Observational, descriptive, cross-sectional study. Data were collected on the clinical-pathological characteristics and evolution of patients aged 70 years or older, treated for BC in the period from 1/1/ 2011 to 31/12/ 2018, at the Hospital de Clínicas. Descriptive statistical tools were used and the Kaplan-Meier method was applied to calculate the overall survival (OS) rate. Results: 31 patients were included; median age at diagnosis was 76.8 years old; the clinical-pathological characteristics were: ductal carcinoma: 71%; HG 1-2: 74.2%; stage I: 54.8%; no axillary metastases: 80.6%; HER2-ER/PR+ 80.6%; HER2+ 16.7%, and triple negative 3.2%. Of all the patients, 29% were diagnosed through screening and 74.2% were treated according to current guidelines, while 38.7% were under-treated and 16.1% over-treated. The median OS was 98.7 months. Conclusions: A minority of patients were diagnosed by screening, the most frequent histological type was ductal and the prevalence of HER2-RE/RP+ tumors was higher than in younger patients. Most patients received standard treatment.

Introdução: Existem poucas diretrizes para o tratamento do câncer de mama (CM) em pacientes idosos, o que pode levar ao sub ou excesso de tratamento. Objetivo: Conhecer as características, manejo e evolução do MC precoce em mulheres idosas. Material e métodos: estudo observacional, descritivo e transversal. Foram coletados dados relacionados às características clínico-patológicas e à evolução dos pacientes com 70 anos ou mais atendidos por CM no período de 01/01/2011 a 31/12/2018, atendidos no Hospital de Clínicas. Ferramentas de estatística descritiva foram usadas e o método de Kaplan-Meier foi usado para calcular a sobrevida global (SVG). Resultados: 31 pacientes foram incluídos; a mediana de idade ao diagnóstico foi de 76,8 anos; as características clínico-patológicas foram: carcinoma ductal: 71%; GH 1-2: 74,2%; estágio I: 54,8%; sem metástases axilares: 80,6%; HER2-RE / RP + 80,6%; HER2 + 16,7% e triplo negativo 3,2%. 29% dos pacientes foram diagnosticados por triagem populacional e 74,2% receberam tratamento de acordo com as diretrizes atuais, enquanto 38,7% foram subtratados e 16,1% supertratados. O SVG médio foi de 98,7 meses. Conclusões: A minoria dos pacientes foi diagnosticada por rastreamento populacional, o tipo histológico mais frequente foi ductal e a prevalência de tumores HER2-RE / RP + foi maior do que em pacientes mais jovens. A maioria dos pacientes recebeu tratamento padrão.

Neoplasias neuroendocrinas del intestino: serie de casos / Intestinal neuroendocrine tumors: case series

RESUMEN: Los tumores neuroendocrinos (TNE) intestinales representan el mayor porcentaje de este tipo de lesiones a nivel del aparato digestivo. El tratamiento de elección es la extirpación de la lesión primaria y sus linfonodos regionales. El objetivo de este estudio es reportar el resultado de pacientes portadores de TNE intestinales, tratados quirúrgicamente, en términos de morbilidad postoperatoria (MPO) y mortalidad. Serie de casos de pacientes con TNE intestinales intervenidos de forma consecutiva en Clínica RedSalud Mayor Temuco, entre 2006 y 2020. Las variables resultado fueron MPO y mortalidad. Otras variables de interés fueron localización y diámetro del tumor, tipo de cirugía y estancia hospitalaria. Se utilizó estadística descriptiva. Se trató a 11 pacientes (54,5 % mujeres), con una mediana de edad de 56 años. El 54,5 % de los tumores se localizó en yeyuno-íleon. La mediana del diámetro tumoral, tiempo quirúrgico y estancia hospitalaria fueron 2 cm, 75 min y 4 días, respectivamente. El tipo de resección más frecuente fue hemicolectomía derecha (63,6 %). La MPO fue 9,1 % (seroma en un paciente). No hubo reintervenciones ni mortalidad operatoria. Con una mediana de seguimiento de 18 meses, no se verificaron recurrencias. Los resultados reportados en relación a MPO y mortalidad, son adecuados en relación con la evidencia publicada.

SUMMARY: Intestinal neuroendocrine tumors (INETs) represent the highest percentage of this type of lesion in the digestive system. The treatment of choice is removal of the primary lesion and its regional lymph nodes. The aim of this study is to report the results of patients with INETs treated surgically, in terms of postoperative morbidity (POM) and mortality. Series of cases of patients with intestinal INETs operated consecutively at Clínica RedSalud Mayor Temuco, between 2006 and 2020. Result variables were POM and mortality. Other variables of interest were location and diameter of the tumor, type of surgery, and hospital stay. Descriptive statistics were used. Eleven patients (54.5 %) were treated, with a median age of 56 years. 54.5 % of the tumors were located in the jejunum-ileum. The median tumor diameter, surgical time, and hospital stay were 2 cm, 75 min, and 4 days, respectively. The most frequent type of resection was right hemicolectomy (63.6 %). The MPO was 9.1 % (seroma in one patient). There were no reoperations or operative mortality. With a median follow-up of 18 months, there were no recurrences. Reported results in relation to POM and mortality are adequate in relation to the published evidence.

Risk factors for survival after head and neck cancer: a cohort study in the south of Espirito Santo state

Introduction: Head and check squamous cell carcinomas (HNSCC) affects the Brazilian population with a high incidence and usually has a poor prognosis. Objective: To evaluate the risk factors for survival of patients diagnosed with HNSCC and investigate the influence of epidemiological and clinical factors on the prognostic of HNSCC in southeastern Brazil. Materials and Methods: Clinical records of 211 patients with head and neck squamous cell carcinomas diagnosed and treated between 2010 and 2018 at a reference hospital for oncology, were selected. Clinical and pathological characteristics at diagnosis and for 5 years follow up were collected. The Kaplan-Meier Curve with the Log-Rank test assessed survival, and forward stepwise multivariate logistic regression model was performed to determine the factors affecting HNSCC survival. Results: The 5-year overall survival was 30.0%. Laryngeal cancer was the most prevalent (34.1%), followed by oropharynx (33.6%) and oral cavity (24.2%). About 64% of patients had locally advanced tumors (T3 and T4) and 75.4% of the patients were diagnosed as being in the advanced clinical stages (III and IV). In the multivariate analysis, the locally advanced tumors (OR=2.748; 95%CI:1.310- 5.765), palliative chemotherapy (OR=15.757; 95%CI:5.868-42.309) and metastasis during oncological follow-up (OR=11.602; 95%CI:1.380-97.507) were associated with a poor prognosis. Conclusion: The survival rate was considered low when compared with the literature. Locally advanced tumors, palliative chemotherapy, and the appearance of metastases during follow-up were considered the most important risk factors associated with a low HNSCC survival.

Introdução: O carcinoma de células escamosas (CCE) de cabeça e pescoço possui alta incidência na população brasileira e normalmente está associado a um prognóstico desfavorável. Objetivo: Avaliar os fatores de risco para sobrevida de pacientes diagnosticados com CCE de cabeça e pescoço e investigar a influência de fatores clínicoepidemiológicos no prognóstico do CCE. Materiais e Métodos: Foram selecionados prontuários de 211 pacientes com CCE de cabeça e pescoço diagnosticados e tratados entre 2010 e 2018 em um hospital de referência em oncologia. Foram coletadas as características clínico-patológicas no momento do diagnóstico e nos 5 anos de acompanhamento. A curva de Kaplan-Meier com o teste Log-Rank avaliou a sobrevivência e o modelo de regressão logística multivariada progressiva foram realizados para determinar os fatores que afetaram a sobrevivência do CCE. Resultados: A sobrevida global em 5 anos foi de 30,0%. O câncer de laringe foi o mais prevalente (34,1%), seguido de orofaringe (33,6%) e cavidade oral (24,2%). 64% dos pacientes apresentavam tumores localmente avançados (T3 e T4) e 75,4% dos pacientes foram diagnosticados em estádios clínicos avançados (III e IV). Na análise multivariada, os tumores localmente avançados (RC = 2,748; IC 95%: 1,310-5,765), quimioterapia paliativa (RC = 15,757; IC 95%: 5,868-42,309) e metástases durante o acompanhamento oncológico (RC = 11,602; IC 95%: 1,380-97,507) foram associados a um pior prognóstico. Conclusão: A taxa de sobrevida foi considerada baixa. Tumores localmente avançados, quimioterapia paliativa e aparecimento de metástases durante o seguimento foram considerados os fatores de risco mais importantes associados a uma baixa sobrevida.

Adenocarcinoma mucinoso de vesícula biliar originado en neoplasia papilar intracolecística / Mucinous adenocarcinoma of the gallbladder originated from intracholecystic papillary neoplasm

RESUMEN La neoplasia papilar intracolecística con carcinoma mucinoso invasor y células en anillo de sello es una variedad de cáncer de vesícula, una patología agresiva y con mal pronóstico, la cual puede presentarse en forma similar a una colecistitis y, a pesar del tratamiento operatorio y quimioterapia posterior, la supervivencia y pronóstico son peores en relación con los otros cánceres de vesícula. Este artículo tie ne por objetivo describir un tipo histológico muy específico, de baja frecuencia, de cáncer de vesícula y el tratamiento realizado.

ABSTRACT Intracholecystic papillary neoplasm with invasive mucinous adenocarcinoma and signet ring cells is a rare, aggressive variety of gallbladder cancer, with symptoms mimicking cholecystitis. Survival and prognosis are worse that other types of gallbladder cancer despite surgery and chemotherapy. The aim of this article is to describe a case of a rare gallbladder cancer with specific histology and the treatment performed

Large basal cell carcinoma defect closure on the lateral cheek using multiple advancement flaps / Cierre de defecto por carcinoma de células basales en la mejilla lateral usando múltiples flaps de avance

Basal cell carcinoma (BCC) is the most common type of nonmelanoma skin cancer (NMSC). It grows slowly and very rarely metastasizes but can cause substantial morbidity due to its tendency to relapse and locally invasive nature, especially when located on the face. Excision surgery is still the gold standard treatment for primary BCC and is usually followed by reconstruction procedure. Skin flap techniques vary widely, one of which is flap advancement technique. The main benefit of flap advancement technique is the ability to hide the excision line, thus resulting in an aesthetically sound outcome. We report a case of 72-year-old female with hyperpigmented plaque brownish lump on the left lateral cheek. A diagnosis of igmented basal cell carcinoma had been confirmed through histopathological examination. The patient was treated with wide excision surgery and the defectwas closed by multiple advancement flaps. Follow-up after three months showed excellent cosmetic and functional outcome.

El carcinoma basocelular (CBC) es el tipo más común de cáncer de piel no melanoma. Crece lentamente y rara vez hace metástasis, pero puede causar una morbilidad sustancial debido a su ubicación en la cara, tendencia a la recidiva y su comportamiento invasivo local. La cirugía de escisión sigue siendo el tratamiento estándar de oro para el CBC primario y generalmente se acompañan de procedimientos reconstructivos. Las técnicas de flap varían ampliamente, una de las cuales es la técnica de avance del colgajo. El principal beneficio de la técnica de avance es la capacidad de ocultar la línea de escisión y, por lo tanto, se obtiene un resultado más estético. En este artículo reportamos el caso de una mujer de 72 años con placa hiperpigmentada y abultada en su mejilla lateral izquierda. Se había confirmado un diagnóstico de carcinoma de células basales pigmentadas mediante un examen histopatológico. El paciente fue tratado con una amplia cirugía de escisión y el defecto fue cerrado por múltiples colgajos de avance. El seguimiento después de tres meses mostró un excelente resultado cosmético y funcional.

Endoclips as novel fiducial markers in trimodality bladder-preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

ABSTRACT Hypothesis: Endoclip can be used as fiducial marker in urology. Objective: To assess the feasibility, cost effectiveness and reliability of endoclips as novel fiducial markers in precision radiotherapy, as part of a trimodality bladder-preserving treatment (TBPT) of muscle-invasive bladder carcinoma. Materials and Methods: This retrospective study was performed at Weifang People's Hospital (Weifang, China) from January 2015 to June 2018. A total of 15 patients underwent TBPT. Endoclips were applied to healthy edges of the resected bladder wall as novel fiducial markers. Radio-sensitizing chemotherapy and routine precision radiotherapy were given. The number and position of the endoclips during radiotherapy sessions were monitored. Complications and tumor recurrence were analyzed. Results: The mean age (±standard deviation) of the patients was 67±10 years (range 46-79). There were 3 females and 12 males. Forty-nine endoclips were applied in all patients (3.3±0.8). The tumor was completely visibly resected in all patients. The number of endoclips remained the same through the planned last radiotherapy session (3.3±0.8), i.e., none were lost. All endoclips were removed after the last radiotherapy session. The average number of follow-up months was 38.9±13.2 (range 11-52). There were no procedure-related complications at discharge or follow-up. At one-year, overall recurrence-free survival was 93.3%. Two patients had recurrences at 18 months and 10 months after TBPT, respectively, and salvage radical cystectomy was performed with no further recurrences. Another patient died due to metastasis 9 months after the completion of therapy. Conclusions: Endoclips are reliable, safe and cost-effective as novel fiducial markers in precision-radiotherapy post-TBPT.

High serum superoxide dismutase activity improves radiation-related quality of life in patients with esophageal squamous cell carcinoma

OBJECTIVES: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors in China. Intensity-modulated radiation therapy and volume-modulated arc therapy have become the main treatments for esophageal carcinoma; however, side effects caused by radiotherapy greatly impact the quality of life in these patients. This study aimed to explore the impact of serum superoxide dismutase (SOD) levels on the prognosis of patients with ESCC undergoing radiotherapy. METHODS: Patients aged between 18 and 80 years with lower-middle ESCC who underwent radiotherapy were eligible for this assessment. Adverse events, responses, treatment outcomes, and overall survival (OS) were assessed. Between 2012 and 2014, 195 patients were enrolled, of which 65 were assigned to the low- and high-SOD groups based on their serum SOD values. RESULTS: The baseline characteristics were similar between the two groups, except for the T staging. Adverse events in the low-SOD group were significantly higher than those in the high-SOD group (radiation esophagitis, p=0.007; radiation pneumonitis, p=0.032; leukopenia, p=0.023; thrombocytopenia, p=0.037; anemia, p=0.041). There were no significant differences in response, treatment outcomes, or OS. CONCLUSION: In conclusion, high serum SOD activity improved post-radiotherapy quality of life but did not impact the prognosis of patients with ESCC. To the best of our knowledge, this study is the first to report that serum SOD activity is associated with radiation-induced toxicity and moderately increased radiotherapeutic response in patients with ESCC undergoing radiotherapy.