Helma Maria Chedid

Tumor de Warthin da glândula parótida: estudo de 70 casos

OBJECTIVE: To report the clinical characteristics, treatment and complication of Warthin tumors. METHODS: we conducted a retrospective study of 70 patients undergoing resection of papillary lymphomatous cystadenoma. Variables: age, sex, ethnicity, presence or absence of smoking, primary site of tumor, tumor size in cm, presence of bilateral tumor, type of operation, multicentricity, treatment complications, recurrence and follow up. RESULTS: Forty-four patients (62.8%) were male and 26 (37.2%) female, with a mean age of 56.7; smoking was present in 55 (78.6%) patients; 66 (94.3%) tumors were unilateral and four (5.7%) bilateral, with an average size of 4.1 cm on physical examination. The complications were 14 (19%) cases of facial paresis and / or paralysis, seroma in 10 (13.8%), Freys syndrome in three (4%), hematoma in two (2.7%) and wound infection in one (1.5%) case. CONCLUSIONS: Warthin tumors have a higher incidence in male smokers and predominantly unilateral location of the parotid gland. Superficial parotidectomy with preservation of facial nerve was effective in 100% cases. Complications were transient paresis or paralysis, seroma, Frey syndrome, hematoma and wound infection.

Diagnostic and therapeutic delay in patients with larynx cancer at a reference public hospital

O carcinoma epidermoide da laringe, apesar dos sintomas precoces, ainda e frequentemente diagnosticado em estadio avancado. Apesar da demora ate chegar ao atendimento especializado, o tempo despendido no diagnostico e a espera para o tratamento definitivo tambem sao importantes para o resultado final. OBJETIVO: Avaliar o intervalo de tempo entre a primeira consulta no especialista e o tratamento nos pacientes com carcinoma epidermoide da laringe. FORMA DE ESTUDO: Coorte historica longitudinal. MATERIAL E METODO: Estudo de 272 pacientes com carcinoma epidermoide da laringe atendidos consecutivamente entre janeiro de 1996 e dezembro de 2004. Avaliadas as caracteristicas clinicas e epidemiologicas, assim como sua relacao com o tempo despendido entre a consulta inicial e o tratamento. RESULTADO: O intervalo de tempo entre a primeira consulta e o inicio do tratamento apresentou mediana de 49 dias e media de 57 dias. Nao houve diferenca em relacao ao estadiamento, faixa etaria, sexo, naturalidade ou escolaridade. CONCLUSAO: O tempo entre o atendimento inicial com especialista e o inicio do tratamento apresentou mediana de 49 dias, similar ao relatado em outros estudos.UNLABELLED Laryngeal squamous cell carcinoma is very often diagnosed at advanced stages. The time interval between the specialist consultation and the start of treatment may contribute to better outcomes. AIM the interval assessment between the first specialist evaluation and the treatment of patients with laryngeal squamous cell carcinoma. STUDY DESIGN longitudinal historical cohort. MATERIALS AND METHODS 272 consecutive patients with laryngeal squamous cell carcinoma seen between January, 1996 and December of 2004. Clinical and epidemiological data were evaluated, as well as their association with the time interval between the first specialist visit and the start of treatment. RESULT the median time between first evaluation and treatment was 49 days. There was no relationship with gender, age, birth place, disease stage or education. CONCLUSION the treatment median delay was 49 days, similar to what has been reported in other studies.

Update of Assessment of Survival in Head and Neck Cancer after Regional Recurrence

Objective. To evaluate site of regional recurrence in patients with squamous cell carcinoma of upper aerodigestive tract after neck dissection and the results of salvage treatment. Methods. 95 patients with regional recurrence as the first manifestation of relapse were selected between 943 patients who underwent neck dissection. We evaluated level and side of recurrence, as well disease control after salvage treatment. Results. Level II was the most frequent site of recurrence. Salvage treatment was performed in 51% of ipsilateral and in 75% of contralateral (nondissected neck) recurrences. Control of the disease 12 months after salvage surgery was 25% in the ipsilateral and 37% in contralateral recurrences. Conclusions. Cervical recurrences occur predominantly in level II. Relapse in level I is frequent only in oral cavity tumors and relapse in level V is rare. The neck recurrence carries a poor prognosis even among patients who underwent retreatment with curative intent.

Prognostic significance of the number of lymph nodes in elective neck dissection for tongue and mouth floor cancers

A presenca de linfonodos metastaticos e aspecto relevante no tratamento do câncer na cabeca e pescoco, resultando em 50% de reducao na sobrevida. OBJETIVO: Avaliar o numero de linfonodos removidos no esvaziamento cervical e sua relacao com o prognostico. METODOS: Estudo retrospectivo de 143 pacientes portadores de carcinoma epidermoide de lingua e soalho bucal, cujo exame histologico evidenciou ausencia de metastases linfonodais. Desses, 119 eram masculinos e 24 femininos, com idade media de 54 anos. Quanto ao sitio do tumor primario, 65 eram na lingua e 78 no soalho bucal. A distribuicao do estadio T foi de quatro T1, 84 T2, 36 T3 e 19 T4. Foram realizados 176 esvaziamentos cervicais, sendo unilateral em 110 casos e bilateral em 33. Desses, 78 radicais e 98 seletivos. Os pacientes foram separados em tres grupos, de acordo com os percentis 33 e 66 do numero de linfonodos ressecados. RESULTADOS: O numero medio de linfonodos ressecados foi de 27, sendo 24 nos esvaziamentos seletivos e 31 nos completos. Nao foram observadas diferencas estatisticamente significantes quando relacionado aos estadios T e N. CONCLUSOES: O maior numero de linfonodos dissecados no esvaziamento cervical identifica um grupo de melhor prognostico nos casos pN0.UNLABELLED The presence of metastatic lymph nodes is a relevant aspect in the treatment of head and neck cancer, bringing about a 50% reduction in survival. OBJECTIVE To assess the number of lymph nodes removed in the neck dissection and their relationship with the prognosis. METHODS A retrospective study involving 143 patients with tongue and mouth floor epidermoid carcinoma, which histological exam showed no lymph node metastases. Among those, 119 were males and 24 females, with mean age of 54 years. As to the primary tumor site, 65 were in the tongue and 78 in the mouth floor. T stage distribution was of four T1, 84 T2, 36 T3 and 19 T4. We carried out 176 neck dissections, unilateral in 110 cases and bilateral in 33. Of these, 78 were radical and 98 selective. The patients were broken down into three groups, according to the 33 and 66 percentiles of the number of lymph nodes resected. RESULTS The mean number of resected lymph nodes was 27; 24 in selective dissections and 31 in the complete ones. We did not have statistically significant differences when associated to the T and N stages. CONCLUSIONS The larger number of lymph nodes dissected in the neck dissection identifies the group of better prognoses among pN0 cases.

Delayed postoperative radiation therapy in local control of squamous cell carcinoma of the tongue and floor of the mouth

Objective To evaluate the effect of time between surgery and postoperative radiation therapy on local recurrence of squamous cell carcinoma of the tongue and floor of the mouth. Methods A total of 154 patients treated between 1996 and 2007 were selected considering local recurrence rate and time of the adjuvant radiotherapy. Results Local recurrence was diagnosed in 54 (35%) patients. Radiation therapy reduced the rate of local recurrences, although with no statistical significance. The time between surgery and initiation of postoperative radiotherapy did not significantly influence the risk of local recurrence in patients referred to adjuvant treatment (p=0.49). Conclusion In the presence of risk factors for local recurrence, a short delay in starting the adjuvant radiation therapy does not contraindicate its performance.

Assessment of demographics factors and clinical staging in patients submitted to salvage surgery for oropharyngeal squamous cell carcinoma

UNLABELLED The usual management of upper aero digestive tract squamous cell carcinoma is surgery associated or not to post surgical radiotherapy. Loco-regional relapses constitute the main failure of the initial treatment and early diagnosis justifies the indication of salvage surgery. AIM Descriptive analysis of demographic data and staging for salvage surgery of oropharynx tumors. MATERIALS AND METHODS We studied retrospectively 78 patients submitted to surgery in all cases; however, just 37 patients received post surgical radiotherapy. RESULTS There was a predominance of males in 70 cases, with mean age of 54.2 years, and 54 patients were Caucasian. The patients were classified as T3 and T4 in 38 cases and 40 patients were classified as N0 neck. 35 patients developed loco-regional distant relapses. 17 patients were submitted to salvage surgery and 12 patients were reclassified as T1; 2 patients T2 and in relation to the clinical stage N, 2 patients were N2a and 2 patients N2b. The average age of the patients submitted to salvage surgery was 52.8 years, with predominance of male Caucasians. CONCLUSION Clinical stage I and II were accorded salvage surgery.

Avaliação de fatores demográficos e estadiamento clínico nos pacientes submetidos a resgate cirúrgico por carcinomas epidermóides de orofaringe

The usual management of upper aero digestive tract squamous cell carcinoma is surgery associated or not to post surgical radiotherapy. Loco-regional relapses constitute the main failure of the initial treatment and early diagnosis justifies the indication of salvage surgery. AIM: Descriptive analysis of demographic data and staging for salvage surgery of oropharynx tumors. MATERIALS AND METHODS: We studied retrospectively 78 patients submitted to surgery in all cases; however, just 37 patients received post surgical radiotherapy. RESULTS: There was a predominance of males in 70 cases, with mean age of 54.2 years, and 54 patients were Caucasian. The patients were classified as T3 and T4 in 38 cases and 40 patients were classified as N0 neck. 35 patients developed loco-regional distant relapses. 17 patients were submitted to salvage surgery and 12 patients were reclassified as T1; 2 patients T2 and in relation to the clinical stage N, 2 patients were N2a and 2 patients N2b. The average age of the patients submitted to salvage surgery was 52.8 years, with predominance of male Caucasians. CONCLUSION: Clinical stage I and II were accorded salvage surgery.

Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral

UNLABELLED Unilateral or bilateral neck dissection must be considered in the treatment of laryngeal cancer AIM To evaluate the prevalence of contralateral metastases in larynx cancer and distribution of these metastases according to lymph node levels in the neck. METHOD Retrospective longitudinal study of 272 charts from patients with squamous cell cancer of the larynx treated between 1996 and 2004; and we selected 104 surgical cases submitted to neck dissection. We evaluated the incidence of bilateral or contralateral metastases, according to the location and extension of the primary tumor, considering the anatomical sub-sites and the midline. RESULTS Contralateral metastases in lateral tumors were observed in 3.5% of glottic lesions and in 26% of supraglottic lesions. Contralateral metastases were uncommon in N0 patients. Lymph nodes levels IIa and III were the most commonly involved in the neck. CONCLUSION In lateral glottic tumors there is no need for elective contralateral neck dissection. In supraglottic lesions without ipsilateral metastases, the incidence of hidden metastasis does not justify elective contralateral dissection. The midline is not a reliable indicator of the risk of contralateral laryngeal tumors.

Tumor de colisão de pele do pescoço

The collision or mixed tumor is a malignant neoplasm of the skin related to sun exposure and incidence rates of up to 1.5%. It displays a distinctive clinical behavior in relation to other malignancies of the skin and the histological diagnosis, characterized by the collision between a basal cell carcinoma and squamous cell carcinoma, i.e., two malignancies with distinct histologies and sharp interface between them. The case reported was of a male, 73-year-old patient, with two cervical lesions progressively growing in recent months. The chosen treatment was surgery. Histological examination showed the presence of squamous cell carcinoma adjacent to basal cell carcinoma. These tumors preferentially occur in light-skinned men in the fifth or sixth decades of life. Their most common location is in the head and neck, especially in the central part of the face. The differential diagnosis of basal-squamous carcinoma is defined by distinct histological criteria, since both tumors have similar clinical behavior. Local recurrence rates vary from 12% to 45%, whereas regional ones are of approximately 7.5%. The main prognostic factors are gender, surgical margins, perineural infiltration and lymph node status. The treatment of choice is resection, radiotherapy being indicated as adjuvant or to inoperable lesions. Local recurrence is the main limiting factor in disease-free survival, with poor results.

Avaliação da sobrevida livre de doença em pacientes com carcinoma epidermoide de laringe submetidos à tratamento radioterápico exclusivo ou associado à quimioterapia

UNLABELLED In early stage (I and II) laryngeal squamous cell carcinoma, both surgery and radiotherapy results in significant local and regional control. In advanced tumors (III and IV), radiotherapy alone has local-regional control rates of 32-43%. AIM To assess disease-free survival in SCC laryngeal carcinoma patients submitted to radiotherapy alone and/or associated with chemotherapy. MATERIALS AND METHODS Retrospective study involving 84 cases of laryngeal SCC treated with radiotherapy or chemotherapy together with radiotherapy. Fifty-three cases were treated with intension to cure and 31 because of impossibility to resect the disease. As to clinical stage (CS), 12 were CS I, 15 II, 21 III and 5 IV. In the second group, 11 cases were EC III and 20 IV. RESULTS Mean age was 60 years, 84.5% were men. Fifty-eight (69.1%) cases had complete response and 26 (30.9%) had persistent or residual disease. Five-year disease-free survival was of 42.5%; 62.5% of the patients with organ preservation indication and 9.75 in the group of irressecable disease. CONCLUSION Disease-free survival of those patients submitted to radiotherapy because of laryngeal SCC was of 62.5%.