Ana María Cano-Valdez

Central odontogenic fibroma: new findings and report of a multicentric collaborative study

OBJECTIVE The aim of this study was to describe the clinicopathologic and immunohistochemical characteristics of 14 cases of central odontogenic fibroma (COF), and the ultrastructural features of 2 of them. STUDY DESIGN Collaborative retrospective study based on the records of 4 oral pathology diagnostic services in Latin America based on the current World Health Organization classification. RESULTS There were 7 male and 7 female patients (mean age 31.8 years). Eight tumors occurred in the maxilla and 6 in the mandible. Thirteen cases were epithelium-rich and 1 epithelium-poor COF. Three were classified as hybrid COF with giant cell lesion. Mean size of the hybrid lesions were larger than pure COF (3.8 vs. 2.4 cm). Odontogenic epithelial islands were immunoreactive for cytokeratin (CK) AE1/AE3, CK5, CK14, CK19, and 34BE12 and negative for CK1 and CK18. Langerhans cells positive for S-100 and CD1a were found within the epithelial islands in 6/6 tested cases. CD68 was expressed in the giant cells of the hybrid lesions and in a few mononuclear cells of 2 cases of COF. Ki-67 index was <1% in all cases. In 6 tumors (42.8%), there were small globular eosinophilic droplets within the epithelial islands, which were positive for collagen type IV, and 9/13 cases (69.2%) were focally positive for smooth muscle actin. In addition to fibroblasts, myofibroblastic differentiation was found in the 2 cases studied ultrastructurally. CONCLUSIONS Immunohistochemistry was useful to confirm the presence of epithelium and to exclude other central fibrous tumors. COF also contains a variable number of mast cells, Langerhans cells, and myofibroblasts, and further studies are needed to better understand the participation of these cells in COF histogenesis.

Adenoid cystic carcinoma of the tongue – clinicopathological study and survival analysis

BackgroundTo review the demographic data of a series of adenoid cystic carcinoma (ACC) of the tongue, as well as to analyze c-kit expression, histopathologic patterns, prognostic factors, evolution, recurrences and/or persistence and survival.MethodsRetrospective study from 1986 to 2006, which reviews a database of 68 patients with diagnosis of head and neck ACC.ResultsWe found eight cases of ACC of the tongue (11.7% of all head and neck ACCs). There were 7 female (87.5%) and 1 male (12.5%) patients, with an average age of 51 years (range 33 to 67 years). Seven patients were surgically treated, three of which required adjuvant treatment. Only one female patient did not accept treatment. Average follow-up time was 5.3 years. Metastases developed in 37% of cases during the follow-up period. Histopathologically, the cribriform pattern predominated (6/8 cases). All cases presented perineural invasion, and one patient also presented vascular invasion. c-kit positivity was observed in all cases. Global survival in the seven treated cases was 51% and 34% at 5 and 10 years, respectively, while the disease-free period was of 64% at 3 years and 42% at 10 years.ConclusionACC of the tongue is a rare neoplasm, in which early diagnosis is important because these are slowly-growing tumors that produce diffuse invasion. As the role of c-kit could not be assesed in this series, surgery continues to be the cornerstone of treatment and radiotherapy is indicated when surgical margins are compromised. Metastatic disease is still hard to handle because of the lack of adequate therapies for these tumors. Hence, survival has not changed in the last years.

Dermatofibroma and Dermatofibrosarcoma Protuberans: A Comparative Ultrastructural Study

Dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) are dermal tumors whose histogenesis has not been well defined to date. The differential diagnosis in most cases is established in routine H/E sections and may be confirmed by immunohistochemistry, but there are atypical variants of DF with less clear histological differences and non-conclusive immunohistochemical results. In those cases, electron microscopy studies may be useful in establishing the diagnosis. The authors describe in detail the ultrastructural characteristics of 38 cases of DFSP and 10 cases of DF. The objective was to establish the ultrastructural features for differential diagnosis, and to identify the possible histogenesis of both neoplasms. DFSP is formed by stellate or spindled cells with long, slender, ramified cell processes joined by primitive junctions. Subplasmalemmal densities were frequently seen in the processes. Another common finding was the presence of multivesicular buds (MVB), peculiar structures that contain microvesicles abutting from the cell membrane. In contrast, DF is characterized by a proliferation of multiple capillary vessels with prominent endothelium and a perivascular population of ovoid or spindled cells devoid of cell processes. These latter cells featured intracytoplasmic lipid material (p < .001), infrequent subplasmalemmal densities (p < .001), and absence of MVB (p < .001). With the ultrastructural characteristics and the constant expression of CD34 in DFSP, a probable origin in dermal dendrocytes is postulated for this tumor. The histogenesis of DF is less clear, but an origin from FXIIIa modified perivascular dermal dendrocytes is proposed.

Necrotizing sialometaplasia of the palate associated with angiocentric T-cell lymphoma.

In this article we present 2 cases of necrotizing sialometaplasia (NS) associated with angiocentric lymphoma of the midline. Immunohistochemical analysis confirmed a T-cell origin, and in situ hybridization in one case revealed its relationship to Epstein-Barr virus. These findings suggest that vascular occlusion by the neoplastic cells produces ischemia, which leads to local infarction contributing to the salivary gland lesion. To our knowledge, the association between angiocentric lymphoma and NS has been previously reported in only one instance, and we suggest that this particular type of lymphoma should be added to the list of related conditions for NS.

Resección de tumor de cuerpo carotideo con LigaSure

OBJECTIVE We carried out this study in patients who underwent resection of carotid body tumour (CBT). Shamblins classification system was used as well as the modified Shamblin classification. We sought to determine whether surgical time and bleeding could be reduced with the use of the LigaSure system. METHODS A prospective study was carried out in patients with CBT. RESULTS A decrease in both time and bleeding was shown, although only overall time showed statistical significance. Cases were classified as Shamblin I, II and III in two, six, and four cases, respectively, and after surgical treatment were classified as modified Shamblin I, II, IIIa and IIIb in two, one, and six cases, respectively, by infiltration to the carotid. There was nerve damage in four cases, and there were three carotid resections. CONCLUSIONS Use of LigaSure decreased bleeding and surgical time in CBTs. Lesions of the artery are mainly caused by infiltration or by muscular hypotrophy of the artery, which frequently requires vascular reconstruction. Nerve injury continues to be an important postoperative complication, which may result in a reduction in the quality of life for the patient. The rates of nerve injury as a result of surgery were unchanged.

Horizontal partial laryngectomy in mucoepidermoid carcinoma of the larynx after failure of laser surgery followed by radiotherapy: a case report

IntroductionTumors of the minor salivary glands in the larynx are rare and represent <1%. They usually appear between the 4th and 7th decades of life. The most common site of occurrence is the supraglottis; however, these neoplasms can appear at any location in the larynx. Pulmonary metastases are the most frequent site for distant disease.Case presentationWe present the case of a 34-year-old Hispanic male with a history of cigarette smoking. He was admitted to our Institution in 2002 with a 1-year evolution of odynophagia, initially to solids and then to liquids. The patient was referred to our Institution for an undifferentiated carcinoma of the epiglottis treated one week earlier with laser surgery and positive surgical margins. Upon admittance, the patient did not demonstrate any tumor activity. A review of the slides confirmed undifferentiated carcinoma. Chemo-radiotherapy was proposed to the patient, but he accepted only radiotherapy and received a total dose of 70 Gy. The patient was followed-up every 3 months. Two years later, follow-up nasofibrolaryngoscopy demonstrated clear evidence of tumor activity at the site of the primary tumor (supraglottis). No cervical adenopathies were found either clinically or radiologically. Biopsy of the lesion was inconclusive; hence, the patient was scheduled for a suspension microlaryngoscopy with transoperative study, performing afterwards a supraglottic horizontal laryngectomy. Histological diagnosis reported ulcerated, high-grade supraglottic mucoepidermoid carcinoma with lymphatic permeation and invasion to the striate muscle and adipose tissue. The borders and surgical bed were free of neoplasm. The patient evolved satisfactorily. At 4 years following treatment, the patient is disease free.ConclusionRecurrence must be considered when planning treatment, and organ preservation surgery is justified, especially in young patients.

Carotid body tumour resection with LigaSure® device

Abstract Objective We carried out this study in patients who underwent resection of carotid body tumour (CBT). Shamblins classification system was used, as well as the modified Shamblin classification. We sought to determine whether surgical time and bleeding could be reduced with the use of the LigaSure® system. Methods A prospective study was carried out in patients with CBT. Results A decrease in both time and bleeding was shown, although only overall time showed statistical significance. Cases were classified as Shamblin I, II and III in two, six, and four cases, respectively, and after surgical treatment were classified as modified Shamblin I, II, IIIa and IIIb in two, one, and six cases, respectively, by infiltration to the carotid. There was nerve damage in four cases, and there were three carotid resections. Conclusions Use of LigaSure® decreased bleeding and surgical time in CBTs. Lesions of the artery are mainly caused by infiltration or by muscular hypotrophy of the artery, which frequently requires vascular reconstruction. Nerve injury continues to be an important postoperative complication, which may result in a reduction in the quality of life for the patient. The rates of nerve injury as a result of surgery were unchanged.

Germ-cell tumors with sarcomatous components. A clinicopathologic and immunohistochemical study of 48 cases

Background The presence of sarcomatous components (SC) in gonadal or extragonadal germ cell tumors (GCT) is an infrequent phenomenon whose clinical outcome and biological significance remains unsettled. It may cause diagnostic pitfalls and treatment failure. In order to define the clinical and pathological characteristics, prognosis and biological behavior of these tumors, a clinicopathologic study of 48 cases of GCT/SC was undertaken, with immunohistochemical studies (IHCS) in 34 of them to define the phenotype of SC.

Brain angiometastasis from a non-seminomatous germ cell tumor: A case report

Highlights • Brain metastasis from non-seminomatous germ cell tumors (NSGCTs) are rare.• Brain metastasis from an NSGCT with high-flow AV shunting are uncommon.• The term angiometastasis corresponding to formation of the brain metastasis from an NSGCT with numerous AV shunts.

Guía de manejo del nódulo tiroideo y del cáncer diferenciado de tiroides de la Sociedad Mexicana de Oncología

Martín Granados-García1*, Francisco Gallegos-Hernández2, Héctor Gurrola-Machuca3, Lorena Flores-Hernández1, Irlanda Pacheco-Bravo1, Michelle Aline Villavicencio-Quejeiro3, Francisco Osvaldo García-Pérez1, Juan Carlos Cruz-López4, Mónica Lizzette Serrano-Arévalo1, Lidia Faridi-Villegas1, Sergio Vázquez-Ciriaco5, Juan José Soto-Ávila6, Sevastían Salvador Medina-Ornelas1, Federico Maldonado-Magos1, María Yicel Bautista-Hernández7, Rubén Figueroa-Aragón2, Samuel Rosales-Pérez2, Mauricio Durán-Cruz8, Gabriela Núñez-Guardado3, Antonio Rojas-Calvillo8, Ana María Cano-Valdez1, Kuauhyama Luna-Ortiz1, Antonio Gómez-Pedraza1, José Alberto Abrego-Vásquez2, Ricardo C. Herrera-Alanís9, Francisco Ochoa-Carrillo1 y Alberto Tavares-de la Paz10, en representación del Grupo de Investigación en Cáncer de Cabeza y Cuello (GICC) de la Sociedad Mexicana de Oncología (GICC-SMeO)