Pathway Analysis using Gene-expression Profiles of HPV-positive and HPV-negative Oropharyngeal Cancer Patients in a Hispanic Population: Methodological Procedures.

OBJECTIVE: The incidence of oral cavity and pharyngeal cancer in Puerto Rican men is higher than it is in the men of any other ethnic/racial group in the United States of America (US). The information regarding the effect of the human papilloma virus (HPV) in the gene-expression profile among patients with this cancer is limited in Hispanic community. We aim to describe the methodology for future studies to identify the molecular networks for determining overrepresented signaling and metabolic canonical pathways, based on the differential gene-expression profiles of HPV+ and HPV- samples from patients with oropharyngeal squamous cell carcinoma in Puerto Rico. METHODS: We analyzed the RNA expression of 5 tissue samples from subjects diagnosed with oropharyngeal squamous cell carcinoma, 2 HPV+ and 3 HPV-, using Affymetrix GeneChips. The relative difference between the average gene expressions of the HPV+ and HPV- samples was assessed, based on the fold change (log2-scale). RESULTS: Our analysis revealed 10 up regulated molecules (Mup1, LRP1, P14KA, ALYREF, and BHMT) and 5 down regulated ones (PSME4, KEAP1, ELK3, FAM186B, and PRELID1), at a cutoff of 1.5-fold change. Ingenuity Pathway Analysis showed the following biological functions to be affected in the HPV+ samples: cancer, hematological disease, and RNA post-transcriptional modification. QRT-PCR analysis confirmed only the differential regulation of ALYREF, KEAP1, and FAM186B genes. CONCLUSION: The relevant methodological procedures described are sufficient to detect the most significant biological functions and pathways according to the HPV status in patients with oropharyngeal cancer in Puerto Rico.

Robotic-assisted salvage supraglottic laryngectomy.

Traditional open surgery has historically been the standard approach to treating many head and neck conditions. The introduction of the first robot into the surgical world in 1985 has been a keystone in the development of minimally invasive surgical (MIS) techniques. Transoral robotic surgery (TORS) is a minimally invasive technique used for the treatment of head and neck pathologies, including benign and malignant lesions. When performed in select patients, TORS offers low post-operative morbidity, along with very few functional and cosmetic compromises. Herein, we present the first TORS supraglottic partial laryngectomy performed in Puerto Rico or in any region in Latin America. A 68-year-old male who had previously undergone radiation therapy presented with hoarseness and weight loss. A suspension microlaryngoscopy showed a lesion of the left false vocal cord; a biopsy was performed. The patient was diagnosed with a supraglottic squamous cell carcinoma (T2N0M0); the tumor was completely excised using TORS. No post-operative complications occurred.

Bilateral vallecular cyst: transoral robotic resection.

Vallecular cyst is more frequent in neonatal life, but could be present in adults. Frequently it is asymptomatic although some people has foreign body sensation upon swallowing and obstructive problems to sleep. The best treatment for these cases is complete resection, as recurrence is usual with any cyst remnant wall causing re-accumulation. We present the case of a patient with symptomatic vallecular cyst treated with transoral robotic surgery. The technique confirmed the advantages related with tridimensional vision close to the cyst, associated with multi-articulated 5 mm EndoWrist® instruments that made real safe and efficient surgery.

Transoral robotic surgery for oncocytic ductal cyst of hypopharynx: a lesion with a high probability of recurrence.

Hypopharyngeal cysts are very uncommon pathology. They are presented in adult people over 60 years. Although oncocytic cysts are benign tumors, an incomplete resection causes recurrence. The symptoms are not specific, but the more frequent are dyspnea and foreign body sensation upon swallowing. Diagnosis usually is under general anesthesia during intubation. A flexible fiberoptic laryngoscopy could be insufficient; the trumpet maneuver during this examination can reveled occult cysts. To perform a total resection, the surgeon must have a complete exposition of the operative field. We present a new case of a patient with a symptomatic hypopharyngeal cyst successfully treated with transoral robotic extirpation; our view was tridimensional magnified and the robotic instruments provided great range of movement that permitted complete and safe removal hypopharyngeal lesion.

Nasal cavity ossifying fibrosarcoma: an unusual fibro-osseous neoplasm.

We describe the case of a 65-year-old woman who presented with left nasal obstruction. Clinical and radiographic examinations revealed the presence of a soft-tissue mass that had obliterated the left nasal cavity. The mass was completely excised via an endoscopic approach. Histopathologic examination identified the tumor as an ossifying fibrosarcoma. The patient recovered uneventfully and remained free of disease at the 2-year postoperative follow-up. To the best of our knowledge, no case of an ossifying fibrosarcoma of the nasal cavity has been previously reported in the English-language literature. We discuss the features of this case and the clinical presentation, diagnosis, and management of fibrosarcomas of the nasal cavity and paranasal sinuses.

Cirugía Robótica Transoral (TORS), en el manejo de lesiones neoplásicas de cabeza y cuello / Transoral Robotic Surgery (TORS), in the management of head and neck tumors

El cáncer de cabeza y cuello es una enfermedad muy complicada cuya incidencia ha venido incrementando en la última década y está relacionada con la infección del virus del papiloma humano. La base del tratamiento es la cirugía, que debe hacerse con intervenciones extensas y mutilantes a través del cuello, son acompañadas de quimioterapia y radioterapia, dejando secuelas funcionales difíciles de manejar. Desde 2009 se aprobó el uso del robot Da Vinci® para resecar tumores de la orofaringe y supraglotis, con la cirugía robótica transoral. Las bondades de esta técnica, que inciden en la pronta recuperación del paciente, y que están derivadas de la excelente visión tridimensional y la versatilidad de movimientos del instrumental articulado (EndoWrist®), han hecho que las recomendaciones de su uso estén redefiniéndose continuamente. Este artículo resume las ventajas, las desventajas, las indicaciones de manejo actual, el cuidado posoperatorio, la rehabilitación y la terapia adyuvante de este novedoso tratamiento.

Head and neck cancer is a complicated disease, with an increasing incidence in the last decade, and is associated with the human papilloma virus infection. The basic treatment is surgery, which should be done with interventions through the neck, which are extensive and crippling, supplemented by chemotherapy and radiotherapy, leaving hard-to-manage functional sequels. The use of the Da Vinci® robot was approved in 2009 for the resection of tumors of the oropharynx and supraglotis, using transoral robotic surgery. The benefits of this technique, leading to an early recovery of the patient, arise from the excellent three-dimensional views and exceptional movements of the automated instrument (EndoWrist®). This has led to the recommendations for its use being continuously redefined. This article summarizes the indications, advantages, disadvantages, postoperative care, management, rehabilitation, and adjuvant therapy of this new treatment.