Ana Lucia Noronha Francisco

Prognostic impact of perineural invasion and lymphovascular invasion in advanced stage oral squamous cell carcinoma

Perineural invasion (PNI) and lymphovascular invasion (LVI) have been associated with the risk of local recurrences and lymph node metastasis. The aim of this study was to evaluate the prognostic impact of PNI and LVI in patients with advanced stage squamous cell carcinoma of the tongue and floor of the mouth. One hundred and forty-two patients without previous treatment were selected. These patients underwent radical surgery with neck dissection and adjuvant treatment. Clinicopathological data were retrieved from the medical charts, including histopathology and surgery reports. Univariate analysis was performed to assess the impact of studied variables on survival. Overall survival was negatively influenced by six tumour-related factors: increasing T stage (P = 0.003), more than two clinically positive nodes (P = 0.002), extracapsular spread of lymph node metastasis (P < 0.001), tumour thickness (P = 0.04), PNI (P < 0.001), and LVI (P = 0.012). Disease-free survival was influenced by PNI (P = 0.04), extracapsular spread of lymph node metastasis (P = 0.008), and N stage (P = 0.006). Multivariate analysis showed PNI to be an independent predictor for overall survival (P = 0.01) and disease-free survival (P = 0.03). Thus the presence of PNI in oral carcinoma surgical specimens has a significant impact on survival outcomes in patients with advanced stage tumours submitted to radical surgery and adjuvant radiotherapy/radiochemotherapy.

Alcohol and tobacco consumption affects bacterial richness in oral cavity mucosa biofilms

BackgroundToday there are more than 2 billion alcohol users and about 1.3 billion tobacco users worldwide. The chronic and heavy use of these two substances is at the heart of numerous diseases and may wreak havoc on the human oral microbiome. This study delves into the changes that alcohol and tobacco may cause on biofilms of the human oral microbiome. To do so, we used swabs to sample the oral biofilm of 22 subjects; including 9 control-individuals with no or very low consumption of alcohol and no consumption of tobacco, 7 who were chronic and heavy users of both substances and 6 active smokers that reported no significant alcohol consumption. DNA was extracted from swabs and the V1 region of the 16S rRNA gene was PCR amplified and sequenced using the Ion Torrent PGM platform, generating 3.7 million high quality reads. DNA sequences were clustered and OTUs were assigned using the ARB SILVA database and Qiime.ResultsWe found no differences in species diversity and evenness among the groups. However, we found a significant decrease in species richness in only smokers and in smokers/drinkers when compared to controls. We found that Neisseria abundance was significantly decreased in both groups when compared to controls. Smokers had significant increases in Prevotella and Capnocytophaga and reductions in Granulicatella, Staphylococcus, Peptostreptococcus and Gemella when compared to the two other groups. Controls showed higher abundance of Aggregibacter, whilst smokers/drinkers had lower abundances of Fusobacteria. Samples from only smokers clustered closer together than to controls and smokers/drinkers, and also had a significant reduction in inter-group dissimilarity distances, indicating a more homogenous group than controls.ConclusionsOur results indicate that the continued use of tobacco or alcohol plus tobacco significantly reduces bacterial richness, which apparently leads to a reduction in inter-group variability, turning the respective biofilms into a more homogenous microenvironment in terms of bacterial community composition, with possible consequences for human oral diseases.

Head and neck mucosal melanoma: clinicopathological analysis of 51 cases treated in a single cancer centre and review of the literature

Head and neck mucosal melanoma (HNMM) is a rare and aggressive malignancy. The objective of this study was to describe the outcomes of patients with HNMM. Clinical and pathological data from 51 patients with primary HNMM were reviewed. All patients were treated at a single cancer centre between 1954 and 2012. Most tumours involved the nasal cavity (35.3%) and upper gingiva (29.4%). The majority of lesions were ulcerated (54.9%) and pigmented (84.3%). Forty-three patients underwent surgical treatment and 21 (41.2%) underwent adjuvant chemotherapy and/or radiotherapy. Eight patients (15.7%) received palliative treatment. The median follow-up period was 21 months. During this period, 30 (58.8%) patients had tumour recurrences. At the last clinical evaluation, only seven (13.7%) patients were alive with no evidence of disease and three (5.9%) were alive with HNMM. There were significant differences in overall survival probability according to the presence of ulceration (P=0.004), metastatic lymph nodes (P=0.003), and treatment including a radical surgical procedure (P<0.001). On multivariate analysis, ulceration was the only variable associated with an increased risk of death. Despite the poor prognosis, there was significant improvement in overall survival in the most recent years in this sample, mainly due to advances in diagnosis and reconstruction techniques.

Prognostic Factors in Patients with Well-Differentiated Thyroid Carcinoma withLocoregional Recurrence Submitted for Salvage Treatment

Background: Well-differentiated thyroid carcinoma is characterized by an excellent prognosis; however, recurrence rates range from 5% to 23%, and mortality after salvage treatment ranges from 38% to 69%. Objectives: To identify prognostic factors in patients who have undergone salvage therapy for well-differentiated thyroid carcinoma. Patients and methods: This is a retrospective cohort series including 102 patients with respectable locoregional recurrences who underwent salvage treatment. One hundred twenty loco-regional recurrences were observed amongst 102 patients. Univariate survival analysis was performed using the Kaplan-Meier method. Results: Five-year overall survival rates were significantly associated with age over 45 years (67.6%) (p <0.0001), site of recurrence (local or regional recurrence and distant metastasis (65.8%), only local recurrence (88.8%), only regional recurrence (92.2%) (p=0.0267), and histology (papillary carcinoma (90.3%) and follicular carcinoma, (72.2%) (P=0.0156). Conclusion: Age over 45 years, follicular carcinoma and location of recurrence were significant prognostic factors in patients with well-differentiated thyroid carcinoma who underwent salvage treatment.

Clinicopathologic analysis of 14 cases of odontogenic myxoma and review of the literature

Background Odontogenic myxoma is a rare benign neoplasm that originates from odontogenic ectomesenchyme. There is no standard of care and recurrences are frequent after conservative surgical procedures. Material and Methods A retrospective study conducted at a single cancer center, with analysis of medical records of all patients diagnosed with odontogenic myxoma from 1980 to 2010, along with a literature review. Results There were 14 patients with diagnosis of odontogenic myxoma (OM). Most patients were female (78.6%) and Caucasian (100%), with ages ranging from 7 to 51 years (21.6 ± 11.6 years). The time period between the first symptom and first consultation ranged from 0 to 60 months (19.4 ± 19.97 months). The most frequent complaints were increased local volume or failure to tooth eruption. The most common tumor site was the mandible (11 cases, 78.5%). About radiological findings, most lesions were multilocular (9 cases, 64.3%) and with imprecise limits (12 cases, 85.7%). Surgery was performed in all cases and curettage was the most applied technique (10 cases, 71.4%). Three patients underwent mandibulectomy and complex reconstructions including iliac crest microvascular flap. Three patients had postoperative complications and 4 had local recurrences of the tumor. The follow up time ranged from 12 to 216 months (112 ± 70.8 months). All patients are without clinical and radiographic evidence of disease. Conclusions OM is a locally aggressive and rare tumor. There is no gold standard surgical management and the therapeutic decision should be individualized taking into account the characteristics and extension of the tumor. Key words:Mandible, myxoma, odontogenic, odontogenic tumor.

Oral Mucosal Melanoma: clinico-pathological analysis of 30 cases in a single center

Financial support: None. Conflicts of interest: No conflicts of interest declared concerning the publication of this article. Submitted: June 15, 2017. Accepted: October 18, 2017. The study was carried out at A.C.Camargo Cancer Center (ACCCC), São Paulo, SP, Brasil. abstract Introduction: Oral mucosa melanoma (OMM) is a rare and aggressive disease comprising 0.26% of all head and neck malignant neoplasms. Affected individuals usually present younger than the other individuals with mucosal melanoma. Surgical treatment with extensive surgical resection was defended as the primary treatment modality, with increasing consideration for postoperative radiotherapy. Objective: The objective of this retrospective study with 30 subjects treated at the A.C. Camargo Cancer Center from 1954 to 2014 was to analyze the characteristics and treatments related to the tumor that could be identified as risk factors for the prognosis and consequently the overall survival. Materials and Methods: The data collected were analyzed by the STATA v.12.0 program and the Kaplan-Meier curves and the log rank test were used to compare the survival curves. Of the 30 cases of oral melanoma, 56.7% (17) were men and 43.3% (13) women with a mean age of 59.7% (19 to 88 years). Regarding the symptomatology in the moment of diagnosis, 53.3% (16) of the individuals denied pain and 60% (18) bleeding. Results: Considering the morphological aspects of the lesions, it was observed that 43.3% (13) had a non-ulcerated surface, 93.3% (28) were pigmented and 63.3% (19) were nodular type. From all cases, 33.3% (10) were classified as T3 tumors and 66.7% (20), as T4. Fifty-six point seven percent (17) of the lesions had slow growth and 46.6% (14) of the individuals had palpable lymph node at the time of diagnosis. Twenty three patients (76.7%) underwent radical surgery; 16.7% (5) only cryotherapy and 6.6% (2) chemotherapy. Conclusion: In this study we observed 23 recurrences and identified as significant factors for survival: ulceration, the T stage, the presence of N+ and the modality of therapy.