RESUMO
INTRODUCTION: Olfactory neuroblastoma (ONB) is a malignant neoplasm that arises from the upper nasal vault. OBJECTIVE: We present a retrospective case series and clinical analysis of 12 ONB cases. MATERIALS AND METHODS: Patients with ONB treated at Mexico´s National Cancer Institute between 2011 and 2018. RESULTS: The Kadish proportion of B, C, and D stage was 16%, 58%, or 25%, respectively. Hyams Grade 1, 2, or 3 was 25%, 50%, and 25%, respectively. The most common surgical approach was the craniofacial in 5 cases (42%), followed by the transfacial in 4 cases (33%), and the endonasal endoscopic approach in 3 cases (25%). Gross total resection was achieved in 8 patients (67%). Five patients (42%) underwent a second operation due to recurrent/progressive disease. The surgical complication rate was 8.3%. Progression-free survival was 41 months and the mean overall survival was 63.6 months. CONCLUSIONS: Surgical resection followed by radiotherapy, and chemotherapy for metastatic and recurrent disease provides the best outcome in terms of survival and recurrence. To the best of our knowledge, this is the first series of cases reported in Mexico.
ANTECEDENTES: El neuroblastoma olfatorio es una neoplasia maligna que se origina en la bóveda nasal superior. OBJETIVO: Presentar una serie de casos y un análisis clínico retrospectivo. MÉTODO: Pacientes con neuroblastoma olfatorio tratados en el Instituto Nacional de Cancerología, de México, entre 2011 y 2018. RESULTADOS: La proporción de Kadish en las etapas B, C y D fue del 16, el 58 y el 25%, respectivamente. Los grados 1, 2 y 3 de Hyams fueron el 25, el 50 y el 25%, respectivamente. El abordaje quirúrgico más frecuente fue el craneofacial, en cinco casos (42%), seguido del transfacial en cuatro (33%) y del abordaje endoscópico endonasal en tres (25%). La resección total macroscópica se logró en ocho pacientes (67%). Cinco pacientes (42%) se sometieron a una segunda operación debido a enfermedad recurrente o progresiva. La tasa de complicaciones quirúrgicas fue del 8,3%. La sobrevida libre de progresión fue de 41 meses y la supervivencia media global fue de 63,6 meses. CONCLUSIONES: La resección quirúrgica seguida de radioterapia y quimioterapia para la enfermedad metastásica y recurrente proporciona el mejor resultado en términos de supervivencia y recurrencia. Hasta donde sabemos, esta es la primera serie de casos reportados en México.
Assuntos
Estesioneuroblastoma Olfatório/terapia , Cavidade Nasal , Recidiva Local de Neoplasia/terapia , Neoplasias Nasais/terapia , Academias e Institutos , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Cisplatino/uso terapêutico , Estesioneuroblastoma Olfatório/diagnóstico por imagem , Estesioneuroblastoma Olfatório/mortalidade , Estesioneuroblastoma Olfatório/patologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Recidiva Local de Neoplasia/mortalidade , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Intervalo Livre de Progressão , Dosagem Radioterapêutica , Radioterapia Adjuvante , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Los pacientes con cáncer avanzado y recurrente de la piel de la cabeza y el cuello requieren agresivos y prolongados procedimientos, además de padecer una elevada morbilidad, para alcanzar márgenes seguros de curación oncológica. Se trataron once pacientes, 7 con carcinomas de células escamosas, 3 con carcinomas de células basales y 1 Schwanoma maligno, con una combinación de craniotomía, cirugía basal craneal y abordaje craneofacial para reconstruir extensos defectos utilizando colgajos libres musculares y cutáneos en una intervención. Grasa, músculo y 1 mm de una capa epidural de un adhesivo biológico (Bioglue) se usaron para sellar suturas durales y obliterar potenciales espacios muertos. No hubo reacciones adversas al adhesivo biológico y ningún paciente presentó otras complicaciones. De los once pacientes, 3 fallecieron por complicaciones médicas: embolismo pulmonar, mielodisplasia tardía e infarto del miocardio. Para el momento de nuestro seguimiento (9-58 meses) ningún paciente ha presentado recurrencias o metástasis distales
Patients with advanced and recurrent head and neck skin cancer need aggressive and prolonged reconstructive procedures, besides suffering high morbidity, to get safe margins of oncology healing. We treated eleven patients, 7 with squamous cell carcinomas, 3 with basal cell carcinomas and 1 malignant Schwanoma, by a combination of craniotomy, basal cranium, surgery and cra-niofacial boarding to reconstruct extensive defects using free muscular and skin flaps in one intervention. Fat, muscle and 1 mm ipidural biological adhesive layer (Bioglue) was used to seal dural sutures and obliterate potential dead spaces. There were no adverse reactions to the biological adhesive and no patients presented other complications. Out of the eleven patients 3 died due to medical complications: lung embolism, late mielodisplasia and myocardial infarction. After 9-58 months follow up none of the patients have presented with recurrent or distal metastasis
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Neoplasias Cutâneas/cirurgia , Neoplasias Faciais/cirurgia , Neoplasias Faciais/patologia , Neoplasias de Cabeça e Pescoço/patologia , Retalhos Cirúrgicos , Neoplasias Nasais/mortalidade , Neoplasias de Células Escamosas/mortalidadeRESUMO
BACKGROUND: Extranodal T/NK cell lymphomas possess distinctive clinico-pathological characteristics: they are angiocentric, exhibit extensive necrosis. Prognosis is poor in the short term. The objective is to explore the expression of different MMPs in the cells and stroma which are around of the blood vessels damaged and their correlation with clinico-pathological parameters. PATIENTS AND METHODS: Twenty cases of this type of lymphomas were studied and collected patient clinical data. The expressions of MMP-1, 2, 3, 9, 11, 13 and TIMP-1, 2 were studied by immunohistochemistry. Ultrastructural studies were performed in two cases. Statistical analysis was done with Fisher's exact test, Chi(2) test. RESULTS: Of the 20 patients, 13 were men with median age of 43 years. In 13 patients the primary tumor was localized in the nasal cavity. Treatment was combined chemotherapy and radiotherapy in 60%. The 55% advanced clinical stages, 70% died from the disease. There were neoplastic cell and peritumoral fibroblasts positivity to MMP-1 and MMP-11 in most of the cases. The MMPs-2, 3 and 9 were expressed in neoplastic cell between 30 to 65%of the cases. TIMP-1 was presented mainly in the epithelium and TIMP-2 was poor expressed of the all cases. CONCLUSION: There were no statistical significance between the different enzymes used and the clinical parameters, besides status and survival of the patients. It is necessary to study more enzymes and focus them to quantify and determine their activity, in order to have a better correlation with histological features in this type of neoplasm.
Assuntos
Biomarcadores Tumorais/análise , Linfoma Extranodal de Células T-NK/mortalidade , Linfoma Extranodal de Células T-NK/patologia , Metaloproteinases da Matriz/metabolismo , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Adulto , Idoso , Biópsia por Agulha , Estudos de Coortes , Terapia Combinada , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Imuno-Histoquímica , Linfoma Extranodal de Células T-NK/genética , Linfoma Extranodal de Células T-NK/terapia , Masculino , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/genética , Metaloproteinase 9 da Matriz/metabolismo , Metaloproteinases da Matriz/genética , Pessoa de Meia-Idade , Neoplasias Nasais/genética , Neoplasias Nasais/terapia , Probabilidade , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Inibidor Tecidual de Metaloproteinase-1/genética , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Inibidor Tecidual de Metaloproteinase-2/genética , Inibidor Tecidual de Metaloproteinase-2/metabolismoRESUMO
AIMS: The aim of the present study is to define prognostic factors, particularly the impact of treatment on paranasal sinus and nasal cavity malignancies. MATERIAL AND METHODS: Retrospective study of patients with maxillary antrum and nasal fossae malignancies. A maxillectomy classification as performed to treat malignancies in our institution is described. Multivariate analysis of prognostic factors was done using the Cox's model. RESULTS: One hundred and nine patients were evaluated. Squamous cell carcinoma was found in 62 cases and in 95 patients the epicentre of the tumour was located in the maxillary antrum. Ten patients were treated with surgery only, 39 patients with surgery and adjuvant radiation therapy, 37 cases received only radiotherapy, and 18 received radiotherapy followed by surgery; in five cases a combination of chemo-radiotherapy was used. Multivariate analysis identified T classification, orbit invasion, N classification, site of origin of tumour in nasal fossae, and no surgical resection as independent prognostic factors (p=0.0001). CONCLUSION: T4 tumours with orbit invasion present bad prognosis as compared to other T4 tumours. Surgical resection should be included in the treatment strategy. Because of the high frequency of lymph-node metastasis, neck treatment should be considered in T4 tumours.
Assuntos
Adenocarcinoma/terapia , Carcinoma de Células Escamosas/terapia , Neoplasias do Seio Maxilar/terapia , Neoplasias Nasais/terapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Humanos , Maxila/cirurgia , Neoplasias do Seio Maxilar/mortalidade , Neoplasias do Seio Maxilar/patologia , Pessoa de Meia-Idade , Cavidade Nasal , Estadiamento de Neoplasias , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Prognóstico , Radioterapia , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Nasal T/NK-cell lymphomas are highly associated with Epstein-Barr virus (EBV). They are more frequent in Asia than in Western countries. In Central and South America there are few studies about nasal T/NK-cell lymphoma and they have shown a strong predominance of this phenotype in Native American descents, supporting the hypothesis of a racial predisposition for the disease. We studied the lymphomas involving midline facial region at a Brazilian institution. T/NK cell lymphomas (16/25) were more frequently found compared to B lymphomas (9 cases, all B large cell). T/NK cell lymphomas involved predominantly the nasal region. Histologically they showed angioinvasion and necrosis. All of them were positive for CD3 and CD56 and showed numerous tumor cells labeled by EBER-1. Although disease was localized in 61% at diagnosis, there was no tendency to cure. The racial distribution of patients with T/NK-cell phenotype was similar to that found in B-cell lymphomas. EBV was more frequently found in adenoids than in palatine tonsils. In inflammatory lesions of the nasal and palatal regions EBV was not found. In the present study the relative frequency of T/NK versus B cell sinonasal lymphomas was high and similar to that observed in other Latin American countries. However, there was not any racial association with T/NK-cell phenotype and the tumor showed an agressive behavior similar to that reported in Asia. The high frequency of EBV-positive lymphocytes in nasopharyngeal lymphoid tissue (adenoids) suggests that they could serve as a reservoir for the virus.
Assuntos
Linfoma de Células T/epidemiologia , Neoplasias Nasais/epidemiologia , População Branca/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Predisposição Genética para Doença , Herpesvirus Humano 4/isolamento & purificação , Humanos , Imuno-Histoquímica , Linfoma de Células T/etiologia , Linfoma de Células T/genética , Linfoma de Células T/mortalidade , Linfoma de Células T/patologia , Linfoma de Células T/virologia , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Neoplasias Nasais/etiologia , Neoplasias Nasais/genética , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Neoplasias Nasais/virologia , Fenótipo , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Se trata de un estudio de prevalencia de las defunciones por tumores malignos del oído, nariz y garganta en Chile, durante el decenio 1982 a 1991, que alcanzaron a 1.850, con una tasa de prevalencia global de 14.9 por 100.000 habitantes, 24.5 por 100.000 varones y 5.5 por 100.000 damas. El Riesgo Relativo del varón es de 4.5 por cada dama fallecida. La localización laríngea es la más frecuente con 1.093 defucniones y una tasa de mortalidad de 8.8 por 100.000 habitantes, 15.3 por 100.000 varones y 2.5 por 100.000 damas, con un Riesgo Relativo de 6.1 varones por cada dama. Las defunciones por estas causas corresponden en 0.4 por ciento a los niños; 95 por ciento se produce después de los 45 años con tasas ascendentes con la edad. Los diagnósticos histológicos, en su gran mayoría, corresponden a neoplasias espino-celulares con diferentes grados de diferenciación
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Neoplasias Otorrinolaringológicas/mortalidade , /estatística & dados numéricos , Neoplasias Orofaríngeas/mortalidade , Neoplasias Laríngeas/mortalidade , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasais/mortalidade , Prevalência , Estudos Transversais , Distribuição por Idade , Distribuição por SexoRESUMO
The tumors I will discuss in this chapter on chemotherapy will be ethesioneuroblastoma, salivary gland tumors, chordoma and nasopharyngeal carcinoma. Due basically to the rarity of these lesions, with the exception of nasopharyngeal carcinoma, there have been no multi-institutional studies of chemotherapy use reported in the literature. As a result, there is no clear-cut consensus on the standard of care as it relates to chemotherapy for these tumors. As with most authors who have previously reviewed these tumor types, I believe it is important for us to propose protocols of therapy and test these in arenas where we can accumulate enough patients for meaningful results. In this way, we can test the apparently active agents and combinations in relapsed or extensive disease. We might also begin to explore concurrent therapy (i.e., concurrent radiation and chemotherapy after the surgical procedure, for example).