Juan Pablo Rodrigo Tapia

Head and Neck Paragangliomas: Revision of 89 Cases in 73 Patients

Introduction Paragangliomas (PGL) are uncommon neuroectodermal tumours. PGL are usually clinically benign tumours, although metastasis has been reported and invasive growth can occur in adjacent tissues ( Material and method Retrospective review of 73 patients with 89 paragangliomas who had undergone resection of the PGL in our hospital. There were 8 patients who displayed multiple PGL. PGL were distributed as follows: 33 were jugular, 17 tympanic, 26 carotid body tumours, and 13 vagal paragangliomas. All these patients had a follow-up time of at least a year. The surgical approach was evaluated in terms of tumour origin, sequelae, and subsequent evolution, as well as the relapses and their relation with location of the primary tumour. Results The treatment was surgical, using complementary radiosurgery in just 1 patient. The type Ainfratemporal fossa approach was used in jugular paragangliomas, the approach was cervical in the carotid and vagal ones and, in the tympanics, a transmeatal or transmastoid approach was performed. In the 73 patients making up our study group, there were 11 recurrences which appeared in jugular paragangliomas (two of them in multiple PGL cases). The post-operative sequelae were mainly cranial nerve paralysis (VII, IX, X, XI, and XII), along with cerebrospinal fluid fistulas in 14 of the jugular PGLs. Conclusions With this article we try to reflect our experience in the treatment of this type of tumour. Surgical treatment achieves excellent control of the disease with an acceptable morbidity in young or middle-aged patients. In order to diminish the probabilities of facial nerve paralysis in jugular PGL we must avoid the facial nerve transposition in the infratemporal approach.

Sinonasal Mucosal Melanomas. Review of 17 Cases

Abstract Introduction Mucosal melanomas (MM) represent 1.3% of all melanomas; 55% of them are located in the head and neck region mainly in the sinonasal and oropharyngeal cavity. Sinonasal mucosal melanomas have a high rate of local recurrence and a high risk of developing metastases, 2 reasons explaining the low survival rate. Material and method We present 17 cases of sinonasal mucosal melanomas that were diagnosed and treated in our department from 1984 to July, 2008. The patients were studied by age, gender, site of presentation of the tumour, symptoms, radiology findings, treatment, and course. Results Seventeen patients with sinonasal mucosal melanomas were studied. Of these 64.7% were females and the mean age at presentation was 74 (range, 48 to 93 years). Twelve cases developed in the nasal cavity and 5 in the paranasal sinuses. The most frequent site of presentation was the septum (35%), and the most common symptom was epistaxis (77%). Three patients rejected any treatment, 12 of the patients were treated surgically, 1 received chemotherapy, and another chemotherapy plus radiation therapy. The 5 year disease-specific survival rate was 35.7%. Discussion and conclusions Sinonasal mucosal melanomas are rare tumours with a high mortality. The treatment of choice is still surgical resection with wide surgical margins. Even so, the main cause of treatment failure is local recurrence, followed by the development of metastases. Because of the poor prognosis with this tumour, new treatment strategies are necessary.

Paragangliomas de cabeza y cuello: revisión de 89 casos en 73 pacientes

Introduccion Los paragangliomas son tumores poco frecuentes de origen neuroectodermico. Se los considera tumores benignos, pero en algunas ocasiones tienen un comportamiento biologico similar a los tumores malignos ( SDHB, SDHC y SDHD , que codifican las subunidades del mismo nombre en el complejo enzimatico mitocondrial de la succinato deshidrogenasa, tienen un papel importante en la patogenia. Material y metodo Se trata de un estudio retrospectivo en el que se revisa a 73 pacientes intervenidos en nuestro servicio con un total de 89 paragangliomas, ya que 8 pacientes presentaban paragangliomas multiples. Los paragangliomas se distribuyeron de la siguiente forma: 33 yugulares, 17 timpanicos, 26 carotideos y 13 vagales. Todos estos pacientes tuvieron un seguimiento minimo de 1 ano. Se evaluaron las vias de abordaje en funcion de la localizacion tumoral, las secuelas acaecidas y su ulterior evolucion, asi como las recurrencias y su relacion con la localizacion del tumor primario. Resultados El tratamiento fue quirurgico, utilizando la radiocirugia como tratamiento complementario en un paciente. En los paragangliomas yugulares se realizo un abordaje infratemporal tipo A, en los carotideos y vagales el abordaje fue cervical y en los timpanicos, transmeatal o transmastoideo. De los 73 pacientes con paragangliomas intervenidos que componen nuestra poblacion en estudio, hubo 11 recurrencias, que aparecieron en los paragangliomas yugulares, que en 2 casos fueron paragangliomas multiples. Las secuelas postoperatorias fueron sobre todo la paralisis de nervios craneales (VII, IX, X, XI y XII), junto con las fistulas de liquido cefalorraquideo en el 14 % de los paragangliomas yugulares. Conclusiones Con este articulo pretendemos reflejar nuestra experiencia en el tratamiento de este tipo de tumores. El tratamiento quirurgico consigue un excelente control de la enfermedad con una morbilidad aceptable en pacientes de mediana edad o jovenes. Para disminuir las probabilidades de paralisis facial en los paragangliomas yugulares, debe evitarse la transposicion del facial en el abordaje infratemporal de la fosa yugular.

Papilomas invertidos rinosinusales. Revisión de 61 casos

INTRODUCTION Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach. MATERIAL AND METHOD We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6-228 months). RESULTS Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22-80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up. DISCUSSION AND CONCLUSIONS The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage.

Melanomas mucosos rinosinusales. Revisión de 17 casos

Introduccion Los melanomas mucosos (MM) representan el 1,3 % del total de melanomas. El 55 % de ellos se encuentra en la region de la cabeza y el cuello, principalmente en el area rinosinusal y la orofaringe. Los MM rinosinusales tienen una alta tasa de recurrencias locales y una gran capacidad para desarrollar metastasis, lo que se traduce en una supervivencia muy corta. Material y metodo Se presentan los MM rinosinusales diagnosticados y tratados en nuestro servicio desde 1984 a julio de 2008. Se recogieron datos clinicopatologicos que incluyen edad, sexo, sitio y sintomas de presentacion, hallazgos radiologicos, tratamiento y evolucion. Resultados Se realiza una revision de 17 pacientes. El 65% eran mujeres. La media (intervalo) de la edad a la presentacion fue 74 (48-93) anos. Los melanomas se originaron en la cavidad nasal en 12 pacientes y en los senos paranasales en 5. El lugar de presentacion mas frecuente fue el septum (67 %), y el sintoma de presentacion fue la epistaxis (77 %). Tres pacientes rehusaron recibir tratamiento, 12 fueron tratados quirurgicamente, 1 con quimioterapia y 1 con quimioterapia y radioterapia. La supervivencia especifica a 5 anos fue del 35,7 %. Discusion y conclusiones Los melanomas rinosinusales son tumores raros pero con una elevada mortalidad. El tratamiento de eleccion sigue siendo la reseccion quirurgica con amplios margenes quirurgicos. A pesar de ello, la principal causa de fracaso del tratamiento son las recidivas locales y el desarrollo de metastasis. Dado el mal pronostico de este tumor, parecen necesarias nuevas estrategias terapeuticas.

Expresión de la anexina A2 en los carcinomas epidermoides de cabeza y cuello

Objetivo La expresion de la anexina A2 (ANXA2) se ha hallado elevada en varios canceres. Sin embargo, no hay datos disponibles de la expresion de esta proteina en los carcinomas epidermoides de cabeza y cuello. El objetivo de este estudio preliminar es investigar la expresion de la ANXA2 en estos carcinomas. Material y metodo Se analizo la expresion de la ANXA2 mediante inmunohistoquimica en muestras incluidas en parafina de 9 lesiones premalignas y 21 carcinomas epidermoides de cabeza y cuello. Resultados Todas las lesiones con displasia mostraron una reduccion en la expresion de la ANXA2 respecto al tejido normal. En contraste, se aprecio expresion de la ANXA2 en todos menos uno de los tumores estudiados. La disminucion de la expresion de la ANXA2 en los carcinomas se correlaciono de forma significativa con una peor diferenciacion histologica, con tumores de mayor tamano y con metastasis ganglionares. Conclusiones Nuestros datos muestran por primera vez que la ANXA2 se expresa en los carcinomas epidermoides de cabeza y cuello e indican que su expresion se relaciona con el grado de diferenciacion de estos tumores.

Annexin A2 Expression in Head and Neck Squamous Cell Carcinoma

Objective Over-expression of annexin A2 (ANXA2) has been reported in various cancers. However, no data are available on the expression of this protein in head and neck squamous cell carcinomas (HNSCC). The objective of this preliminary study is to investigate the expression of ANXA2 in these carcinomas. Material and method ANXA2 expression was analyzed by immunohistochemistry in paraffin-embedded sections from 9 patients with premalignant lesions and 21 patients with HNSCC. Results All dysplastic tissues showed significantly reduced ANXA2 expression compared to normal tissue. In contrast, ANXA2 expression was observed in all but 1 of the tumours studied. There was a significant correlation of lower ANXA2 expression with a poorer histological differentiation, larger tumours, and nodal metastases. Conclusions Our data show for the first time that ANXA2 is expressed in head and neck squamous cell carcinomas and that its expression seems to be related with the degree of differentiation status of these tumours.

Inverted sinonasal papillomas. Review of 61 cases

Abstract Introduction Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall that are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this study is to analyse our experience in the treatment of these lesions, especially through the endoscopic approach. Material and methods We present 61 cases of sinonasal inverted papillomas that have been treated at our hospital since 1983. The patients were studied by age, gender, tumour presentation site, symptoms, radiological studies, surgical treatment, and evolution. The mean follow-up was 51 months (range, 6–228 months). Results Thirty-eight of the patients (62%) were males and 23, females (38%). The average age was 58 (range, 22–80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28%, and the lateral nasal wall in 21% of the cases. Seventy-eight percent of cases had associated sinusitis and 43% polyposis. Tumours were classified with the Krouse staging system as follows: thirty-five percent stage I, 37% stage II, 18% stage III, and 8% stage IV. Thirty-seven percent of the patients showed bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. Seventeen percent of the patients had malignant inverted papillomas, 9 of them diagnosed from the beginning as malignant neoplasm and 1 that became malignant during follow up. Discussion and conclusions The endoscopic approach is the method of choice for treatment of the majority of inverted papillomas. The close follow up of the patient for a long period of time is necessary for early detection of recurrence and to allow for surgical salvage.

Neuritis óptica retrobulbar reversible por sinupatía esfenoidal: dos casos clínicos

Las neuritis opticas pueden estar producidas por una gran variedad de enfermedades y se manifiestan clinicamente como una perdida de vision temporal pero severa. Es raro que sinusitis esfenoidales coexistan con neuritis opticas agudas, por lo que su relacion invita a la sospecha etiologica. Presentamos 2 casos en los que la primera manifestacion de una afeccion infecciosa esfenoidal fue una neuritis optica retrobulbar que revirtio tras el tratamiento, medico, en un caso, y quirurgico, en el otro, de la sinusitis.

Reversible Retrobulbar Optic Neuritis Due to Sphenoidal Sinus Disorders: Two Case Studies

Optic neuritis are clinically demonstrated by a temporary but severe loss of vision and can be caused by a wide variety of diseases. It is unusual for sphenoidal sinusitis to co-exist with acute optic neuritis, so the simultaneous appearance of both diseases would invite aetiological suspicion. We present 2 cases where the first clinical manifestation of infectious sphenoidal pathology was retrobulbar optic neuritis, which reverted with treatment, medical in one case and surgical in the other, of the sinusitis.