Kuauhyama Luna-Ortiz

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.

Prognostic factors in patients with minor salivary gland carcinoma of the oral cavity and oropharynx

This study was performed to define prognostic factors and management of minor salivary gland carcinoma of the oral cavity and oropharynx .

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy in patients with radiation therapy failure

BackgroundTo assess functional results, complications, and success of larynx preservation in patients with recurrent squamous cell carcinoma after radiotherapy.MethodsFrom a database of 40 patients who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) from June 2001 to April 2006, eight patients were treated previously with radiotherapy due to squamous cell carcinoma of the glottic region and were treated for recurrence at the site of the primary cancer.ResultsSCPL with CHEP was performed in six men and two women with a mean age of 67 years due to recurrence and/or persistence at a mean time of 30 months postradiotherapy (in case #8 after concomitant chemoradiotherapy). Bilateral neck dissection at levels II-V was performed in six patients. Only case #8 presented metastasis in one node. In case #5, Delphian node was positive. It was possible to preserve both arytenoids in five cases. Definitive surgical margins were negative. Complications were encountered in seven patients. Follow-up was on average 44 months (range: 20-67 months). Organ preservation in this series was 75%, and local control was 87%. Overall 5-year survival was 50%.ConclusionsIn selected patient with persistence and/or recurrence after radiotherapy due to cancer of the larynx, SCPL with CHEP seems to be feasible with acceptable local control and toxicity. Complications may occur as in previously non-irradiated patients. These complications must be treated conservatively to avoid altering laryngeal function.

Synovial sarcomas of the head and neck: Comparative analysis with synovial sarcoma of the extremities

OBJECTIVE This study analyzed synovial sarcoma (SS) of the head and neck in order to identify features associated with survival improvement and compared them with the survival of SS of limbs. METHODS Clinical charts and histopathologic material with analysis for SYT/SSX gene rearrangement of 16 patients were reviewed. The clinicopathologic features and their association with survival were analyzed and compared with 174 SS of limbs. RESULTS The average age was 24.2 years (range 21-86). Eight cases occurred in each sex. The most frequent site was the parapharyngeal space (PPS). The mean tumor size was 5.38cm. Sixty-nine percent occurred in Stages II-III and 9% in Stage IV. Fifteen cases were excised: R0 resection in seven (46.7%) cases and R1 resection in eight (53.3%) cases. No patient with R0 resection has recurred, and three patients (37.5%) with R1 resection have recurred (p=0.035). Patients with R0 surgery had better survival rates compared to those who received other treatments (p=0.045). SS of head and neck showed a 5-year survival rate of 58% compared to 44.6% of the limbs (p=0.450). CONCLUSION The most prevalent location was the PPS. Surgical resection with clear margins correlated with low recurrence. Head and neck sarcomas had similar survival rates compared to sarcomas of limbs.

Malignant myoepithelioma of the soft palate

Malignant myoepitheliomas (MM) (myoepithelial carcinomas) are rare tumors representing <1% of salivary gland tumors. They are characterized as being locally aggressive. Rarely do they present distant metastases; however, when they do metastasize the sites most affected are the lungs, liver, pleura, peritoneum and skin. They may originate de novo in a pleomorphic adenoma or a benign myoepithelioma. We report the case of a patient with a submucosal lesion of the soft palate measuring ∼4cm×3cm. The patient underwent transoral resection with a microscope and CO2 laser. Histopathological report was MM originating in a pleomorphic adenoma. Management of this neoplasm is controversial. Myoepithelial carcinoma is a rare neoplasm whose diagnosis includes immunohistochemical (IHC) studies. Surgery is the cornerstone of treatment. Management with laser surgery may preserve the function of the soft palate without deterioration of the quality of life in these patients.

[Laryngeal cancer in patients younger vs older than 40 years old: a matched-paired analysis].

Abstract Background To compare clinical and demographic data between laryngeal cancer patients younger and older than 40 years old. Methods Is a matched-paired study, realized from 1989 to 2002. We selected 500 laryngeal cancer patients treated in the National Cancer Institute of Mexico. Fifteen cases of patients younger than 40 years that accomplished inclusion criteria were identified, pair-matched and compared by clinical stage with 33 patients older than 40 years. We analyzed demographic factors and disease-free and Overall Survival by Kaplan-Meier method. Results We included 9 male and 6 female patients with a mean age of 34 years in contrast to a mean age of 62 years in the comparison group. Four cases in clinical stage I, none clinical stage II, 6 in stage III and 5 in stage IV were included in the younger group and compared to 8 patients in stage I, 15 in stage III and 10 in stage IV in the older group. No differences in demographic variables or lifestyle habits were found. All patients in stage I, are alive in both groups. Diseasefree survival not show any differences when comparing stages III and IV (P=NS). Mean diseasefree survival was 66 months and mean overall survival was 83 months in the younger group. Conclusion Laryngeal carcinoma is rare in patients younger than 40 years. No gender, clinical or prognostic differences could be identified among the two groups. The prognosis of these patients seems to be only determined by the initial clinical stage.

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.

Percutaneous endoscopic gastrostomy as a multidisciplinary treatment in head and neck cancer

The objective of this study was to evaluate the results of using the percutaneous endoscopic gastrostomy (PEG) in patients with head and neck cancer.Forty-six patients with head or neck cancer who required a PEG were evaluated over a 3-year period. The main indications were dysphagia and as a palliative treatment. The early perioperative and short and long term complications were assessed as well as the morbidity and mortality rate related to the procedure.In all cases, the PEG was successfully placed. Perioperative complications were observed in 6 (13%) cases, and the short and long term morbidity were seen in 4 (9%) cases. The side effects were considered as minor in all but 1 case, which required open surgery to remove the gastric tube because its bumper had become fully imbedded in the gastric wall after a 1-year period. No patient died from the procedure.PEG is an easy, quick and safe technique for the short and long term nutrition in head and neck cancer patients, who need a combined treatment of chemotherapy, surgery and/or radiotherapy and in which complications related to any of these treatment were expected. PEG should be placed routinely if enteral feeding with a gastric tube is expected to be longer than 3 weeks.ResumenEvaluar los resultados del empleo de la gastrostomía endoscópica percutánea (GEP) en pacientes con cáncer de cabeza y cuello.Evaluamos a 46 pacientes con cáncer de cabeza o cuello que requirieron GEP durante un período de 3 años. Las principales indicaciones fueron disfagia y como tratamiento paliativo. Valoramos las complicationes perioperatorias tempranas y las complicaciones a corto y a largo plazo, así como la morbilidad y la tasa de mortalidad relacionadas con el procedimiento.En todos los casos la GEP se situó de modo satisfactorio. Observamos complicaciones perioperatorias en 6 (13%) casos y se observó morbilidad a corto y a largo plazo en 4 (9%) casos. Consideramos como menores los effectos secundarios en todos los casos menos en 1, que precisó cirugía abierta para retirar la sonda gástrica debido a que su tope se había incrustado completamente en la pared gástrica después de un período de 1 año. Ninguno de los pacientes falleció como consecuencia del procedimiento.La GEP es una técnica fácil, rápida y segura para la nutrición a corto y largo plazo de los pacientes con cáncer de cabeza o cuello que necesitan un tratamiento combinado de quimioterapia y cirugía con o sin radioterapia y en los que se esperan complicacions relacionadas con cualquiera de estas modalidades de tratamiento. Se debe realizar las gastrostomía endoscópica percutánea de modo rutinario si se espera que la alimentación por vía entérica con una sonda gástrica vaya a superar las 3 semanas de duración.

Adenoid cystic carcinoma of the larynx: a case report and review of the literature

ResumenEl carcinoma adenoideo quístico de laringe (CAQL) es una entidad clinicopatológica rara de comportamiento biológico lento, pero con un alto porcentaje de recurrencia local y metástasis a distancia. El objetivo es ejemplificar el comportamiento del CAQL. Una mujer de 54 años de edad con antecedentes de disfonía durante un período de 6 años antes de su ingreso en el Instituto Nacional de Cancerología (México), tratada con fonocirugía, la cual permaneció asintomática durante 4 años. Posteriormente comenzó de nuevo con disfonía con períodos de disnea, por lo cual se le realizó laringoscopia directa, encontrando un tumor que obstruía la luz laríngea a nivel de la subglotis. Se realizó biopsia de la lesión, de la que se obtuvo el resultado de carcinoma adenoideo quístico. La paciente fue admitida para realizar laringectomía total con resección traqueal hasta el séptimo cartílago traqueal y combinando radioterapia adyuvante (70 Gy) al sitio del primario y al cuello, permitiendo una supervivencia de dos años. El estudio histopatológico macroscópico reveló un tumor laríngeo localizado en la región subglótica. La paciente no presentó complicaciones durante el postoperatorio, quedando con traqueostomía permanente.La resección quirúrgica es el tratamiento de primera elección para el manejo de este tipo de tumor, seguido de radioterapia para los bordes quirúrgicos.

Conjunctival melanoma: survival analysis in twenty-two Mexican patients

PURPOSE To describe the cases of conjunctival melanoma (CM) and report the disease-free interval (DFI) and overall survival (OS). METHODS The charts of 22 patients who were admitted to two hospitals between 1985 and 2006 were reviewed for pertinent data, including demographics, site of involvement in the conjunctiva and sub-sites, surgical treatment, and adjuvant treatment. RESULTS There were 10 (45.45%) males and 12 (54.55%) females. Mean age was 52.3 years. In this group, 15 patients (68.1%) involved the bulbar conjunctiva, and 7 (31.9%) involved the palpebral conjunctiva. Of the 22 patients, 72.72% had a history of conjunctival melanosis. The average tumor size was 20.4 mm. Eight (36.36%) patients underwent orbital exenteration, 2 (9.06%) had enucleation, 5 (22.72%) had wide excision of the lesion followed by radiotherapy, 2 (9.06%) had orbital exenteration with neck dissection, and the remaining 5 patients (22.72%) were considered adequately treated only with wide excision. Eight (36.36%) patients received adjuvant treatment. Disease-free survival at 5 years was 51% and the overall survival at 5 and 10 years was 50% and 37%, respectively. CONCLUSION Conjunctival melanoma is a rare entity. Tumor behavior is aggressive, and the optimal treatment is surgery with adjuvant therapy.