Giant pleomorphic adenoma of the parotid gland

Pleomorphic adenoma is the most common type of all benign and malignant salivary gland tumors, involving more frequently the parotid gland. It is a benign tumor with a slow and continuous growth that without treatment can reach an enormous size. We present a case of a giant pleomorphic adenoma in a 78-year-old man with a history of more than 30 years of a growing lesion in the parotid gland. Clinical examination revealed a giant mass on the right side of the face, however without any sign of facial nerve damage. The tumor was completely resected by total parotidectomy and preservation of the facial nerve. Macroscopically, the tumor measured 28cm and weighed 4.0 Kg. On the histological examination there was a predominance of epithelial and mioepithelial cells in a hyaline and mixoid stroma. It was not found any area of malignant transformation. In the post-operatory the aesthetic and functional results were excellent

TIMP3 and CCNA1 hypermethylation in HNSCC is associated with an increased incidence of second primary tumors

Background: Hypermethylation in the promoter regions is associated with the suppression of gene expression and has been considered a potential molecular marker for several tumor types, including head and neck squamous cell carcinomas (HNSCC).Methods: To evaluate the gene hypermethylation profile as a prognostic marker, this retrospective study used a QMSP approach to determine the methylation status of 19 genes in 70 HNSCC patients.Results: the methylation profile analysis of primary HNSCC revealed that genes CCNA1, DAPK, MGMT, TIMP3 and SFRP1 were frequently hypermethylated, with high specificity and sensitivity. TIMP3 and CCNA1 hypermethylation was significantly associated with lower rates of second primary tumor-free survival (p = 0.007 and p = 0.001; log-rank test, respectively).Conclusion: This study, for the first time, presents CCNA1 and TIMP3 hypermethylation as a helpful tool to identify HNSCC subjects at risk of developing second primary carcinomas.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Biol Sci, Lab Mol Canc Biol, BR-04039020 São Paulo, BrazilBarretos Canc Hosp, Stat & Epidemiol Ctr, BR-14784400 Barretos, BrazilAC Camargo Hosp, Dept Head & Neck Surg, BR-01509010 São Paulo, BrazilBarretos Canc Hosp, Dept Head & Neck Surg, BR-14784400 Barretos, BrazilDuke NUS Grad Med Sch, Canc & Stem Cell Biol Program, Singapore 169857, SingaporeUniversidade Federal de São Paulo, Dept Biol Sci, Lab Mol Canc Biol, BR-04039020 São Paulo, BrazilWeb of Scienc

Clinicopathologic analysis of 14 cases of odontogenic myxoma and review of the literature

Odontogenic myxoma is a rare benign neoplasm that originates from odontogenic ectomesenchyme. There is no standard of care and recurrences are frequent after conservative surgical procedures. A retrospective study conducted at a single cancer center, with analysis of medical records of all patients diagnosed with odontogenic myxoma from 1980 to 2010, along with a literature review. There were 14 patients with diagnosis of odontogenic myxoma (OM). Most patients were female (78.6%) and Caucasian (100%), with ages ranging from 7 to 51 years (21.6 ± 11.6 years). The time period between the first symptom and first consultation ranged from 0 to 60 months (19.4 ± 19.97 months). The most frequent complaints were increased local volume or failure to tooth eruption. The most common tumor site was the mandible (11 cases, 78.5%). About radiological findings, most lesions were multilocular (9 cases, 64.3%) and with imprecise limits (12 cases, 85.7%). Surgery was performed in all cases and curettage was the most applied technique (10 cases, 71.4%). Three patients underwent mandibulectomy and complex reconstructions including iliac crest microvascular flap. Three patients had postoperative complications and 4 had local recurrences of the tumor. The follow up time ranged from 12 to 216 months (112 ± 70.8 months). All patients are without clinical and radiographic evidence of disease. OM is a locally aggressive and rare tumor. There is no gold standard surgical management and the therapeutic decision should be individualized taking into account the characteristics and extension of the tumor

Padrões dietéticos e risco de câncer oral: estudo caso-controle em São Paulo

OBJECTIVE: To analyze the association between dietary patterns and oral cancer. METHODS: The study, part of a Latin American multicenter hospital-based case-control study, was conducted in São Paulo, Southeastern Brazil, between November 1998 and March 2002 and included 366 incident cases of oral cancer and 469 controls, frequency-matched with cases by sex and age. Dietary data were collected using a food frequency questionnaire. The risk associated with the intake of food groups defined a posteriori, through factor analysis (called factors), was assessed. The first factor, labeled prudent, was characterized by the intake of vegetables, fruit, cheese, and poultry. The second factor, traditional, consisted of the intake of rice, pasta, pulses, and meat. The third factor, snacks, was characterized as the intake of bread, butter, salami, cheese, cakes, and desserts. The fourth, monotonous, was inversely associated with the intake of fruit, vegetables and most other food items. Factor scores for each component retained were calculated for cases and controls. After categorization of factor scores into tertiles according to the distribution of controls, odds ratios and 95% confidence intervals were calculated using unconditional multiple logistic regression. RESULTS: Traditional factor showed an inverse association with cancer (OR=0.51; 95% CI: 0.32; 0.81, p-value for trend 0.14), whereas monotonous was positively associated with the outcome (OR=1.78; 95% CI: 1.78; 2.85, p-value for trend <0.001). CONCLUSIONS: The study data suggest that the traditional Brazilian diet, consisting of rice and beans plus moderate amounts of meat, may confer protection against oral cancer, independently of any other risk factors such as alcohol intake and smoking.OBJETIVO: Analisar padrões dietéticos relacionados com o câncer oral. MÉTODOS: Estudo caso-controle de base hospitalar, parte de um estudo multicêntrico na América Latina, foi realizado em São Paulo entre novembro de 1998 e março de 2003 em 366 casos incidentes de câncer oral e 469 controles, pareados por freqüência de sexo e idade. O inquérito dietético foi realizado por questionário de freqüência alimentar. Analisou-se o risco associado ao consumo de grupos de alimentos definidos a posteriori, por análise fatorial. O primeiro fator, denominado prudente, caracterizou-se pelo consumo de vegetais, frutas, queijos e aves. O segundo, tradicional, pelo consumo de arroz e massas, leguminosas e carne, enquanto o terceiro, lanches, pelo consumo de pão, manteiga, embutidos, queijos e doces. O último, monótono, associou-se inversamente ao consumo de frutas e vegetais, e a maior parte dos outros itens alimentares. Calculou-se um escore para cada padrão derivado, para casos e controles. Após categorização dos escores em tercis, de acordo com a distribuição dos controles, estimou-se a odds ratio e o intervalo de confiança de 95% por regressão logística múltipla não condicional. RESULTADOS: O padrão tradicional relacionou-se inversamente com o câncer oral (OR=0,51; IC 95%: 0,32; 0.81, p=0,140), enquanto o padrão monótono associou-se positivamente (OR=1,78; IC 95%: 1,78; 2,85, p<0,001). CONCLUSÕES: Os resultados sugerem que o prato tradicional do brasileiro, composto de arroz e feijão, mais quantidades moderadas de carne, pode conferir proteção quanto ao câncer oral, independente de outros fatores de risco reconhecidos, como consumo de álcool e tabaco.Universidade de São Paulo Faculdade de Saúde Pública Departamento de NutriçãoInstituto do Câncer Arnaldo Vieira de Carvalho Departamento de Cabeça e PescoçoHospital do Câncer A.C.Camargo Departamento de Cabeça, Pescoço e OtorrinolaringologiaHospital Heliópolis Departamento de Cabeça e PescoçoUniversidade Federal de São Paulo (UNIFESP) Departamento de Otorrinolaringologia, Cabeça e Pescoço. Hospital São PauloUSP FSP Departamento de EpidemiologiaUSP Faculdade de Medicina Departamento de Medicina PreventivaUNIFESP, Depto. de Otorrinolaringologia, Cabeça e Pescoço. Hospital São PauloSciEL

Dietary factors and oral cancer: a case-control study in Greater Metropolitan São Paulo, Brazil

Dietary factors associated with oral cancer were investigated in a case-control hospital-based study in the city of São Paulo, Brazil, from 1998 to 2002. A total of 835 subjects, 366 with histologically confirmed incident cases of oral-cavity or pharyngeal cancer and 469 controls participated in the study. Dietary data were collected with a food frequency questionnaire (FFQ). Odds ratios (OR) and 95% confidence intervals (95%CI) were obtained from unconditional logistic regression, adjusted for potential confounders. Inverse associations with risk of oral cancer were found for the highest intake of beans, OR = 0.37 (95%CI: 0.22-0.64), raw vegetables, OR = 0.51 (95%CI: 0.29-0.93) and the intermediate tertile of rice and pasta intake, OR = 0.56 (95%CI: 0.38-0.83). Positive associations were observed for the highest intake of eggs, OR = 1.84 (95%CI: 1.23-2.75), potatoes, OR = 2.22 (95%CI: 1.53-3.25), and milk, OR= 1.80 (95%CI: 1.09-2.98). Some traditional Brazilian foods like rice and beans emerged as protective factors against oral cancer, independently of other risk factors.Neste estudo, investigou-se os fatores dietéticos associados com o câncer oral, em um estudo tipo caso-controle de base hospitalar no Município de São Paulo, Brasil, entre 1998 e 2002. Participaram 835 indivíduos, sendo 366 casos incidentes de câncer de cavidade oral ou faringe e 469 controles. Os dados de consumo alimentar foram obtidos por um Questionário de Freqüência Alimentar (QFA). Os valores de odds ratio (OR) e intervalos com 95% de confiança (IC95%) foram estimados por regressão logística não condicional, ajustada por potenciais fatores de confusão. Verificaram-se associações inversas entre o câncer oral e o consumo mais elevado de feijão, OR = 0,37 (IC95%: 0,22-0,64), vegetais crus, OR = 0,51 (IC95%: 0,29-0,93) e para o tercil intermediário de arroz e massas, OR = 0,56 (IC95%: 0,38-0,83). Associações diretas foram observadas para o mais elevado consumo de ovos, OR = 1,84 (IC95%: 1,23-2,75), batata, OR = 2,22 (IC95%: 1,53-3,25) e leite, OR= 1,80 (IC95%: 1,09-2,98). Alimentos básicos da dieta do brasileiro, como arroz e feijão, emergiram como fatores de proteção para o câncer oral, independente de outros fatores de risco.Universidade de São Paulo Faculdade de Saúde PúblicaInstituto do Câncer Arnaldo Vieira de Carvalho Departamento de Cabeça e PescoçoHospital Heliópolis Departamento de Cabeça e PescoçoUniversidade Federal de São Paulo (UNIFESP) Hospital São PauloUNIFESP, Hospital São PauloSciEL

Decreased CD1a + and CD83 + cells in tonsillar squamous cell carcinoma regardless of HPV status

Dendritic cells (DCs) are specialized antigen-presenting cells that play a critical role in the immune response against human papillomavirus (HPV) infection, and represent a therapeutic target in cancer. Objective: To identify and quantify DCs in tonsillar squamous cell carcinoma (TSCC) under the influence of HPV infection. Methodology: CD1a and CD83 antibodies were used to identify immature dendritic cells and mature dendritic cells by immunohistochemistry in 33 primary TSCC and 10 normal tonsils (NTs), respectively. For the TSCC samples, the number of DCs per area was evaluated in the intra- and peritumoral compartments. For the NTs, the quantification of DCs was evaluated in the intra- and peritonsillar compartments. HPV detection methods were determined according to the ASCO Clinical Practice Guidelines from the College of American Pathologists Guideline (2018). Results: There were fewer intratumoral CD1a+ DCs in the HPV-positive and HPV-negative TSCC groups than in the NT group (p&lt;0.05). In the peritumoral compartment, there were fewer CD83+ DCs in the HPV-positive and HPV-negative TSCC groups than in the NT group (p&lt;0.001). The quantification of DCs subtypes showed no statistical differences between HPV-positive and HPV-negative TSCC groups (p&gt;0.137). Patients with HPV-positive TSCC had significantly better overall survival rate than those with HPV-negative TSCC (p=0.004). Conclusion: Tumor activity contributes to DC depletion regardless of intralesional HPV positivity. An improved prognosis has been reported in patients with HPV-positive TSCC

Patient Concerns Inventory for head and neck cancer: Brazilian cultural adaptation

Objective: The purpose of this study was to translate, culturally validate and evaluate the Patients Concerns Inventory - Head and Neck (PCI- H&amp;N) in a consecutive series of Brazilian patients. Methods: This study included adult patients treated for upper aerodigestive tract (UADT) cancer. The translation and cultural adaptation of the PCI–H&amp;N followed internationally accepted guidelines and included a pretest sample of patients that completed the first Brazilian-Portuguese version of the PCI. The use/feasibility/acceptability of the PCI was tested subsequently in a consecutive series of UADT cancer patients that completed the final Brazilian-Portuguese version of the PCI and a Brazilian-Portuguese version of the University of Washington Quality of Life Questionnaire (UW-QOL). Associations between physical and socio emotional composite scores from the UW-QOL and PCI were analyzed. Results: Twenty patients participated in the pretest survey (translation and cultural adaptation process), and 84 patients were analysed in the cultural validation study. Issues most selected were: fear of cancer returning, dry mouth, chewing/eating, speech/voice/being understood, swallowing, dental health/teeth, anxiety, fatigue/tiredness, taste and fear of adverse events. The three specialists most selected were speech therapist, dentist and psychologist. Statistically significant relationships between PCI and UW-QOL were found. Conclusions: The translation and cultural adaptation of the PCI for Brazilian-Portuguese language was successful, and the results demonstrate its feasibility and usefulness, making this a valuable tool for use within the Brazilian H&amp;N cancer population

Cell-in-cell phenomenon associates with aggressive characteristics and cancer-related mortality in early oral tongue cancer

BackgroundCell-in-cell structures (caused by cell cannibalistic activity) have been related to prognosis of many cancers. This is the first multi-institutional study to assess the prognostic impact of cell-in-cell structures in a large cohort of early oral tongue squamous cell carcinomas (OTSCC).MethodsA total of 308 cases from five Finnish University Hospitals and from the A.C. Camargo Cancer Center, SAo Paulo, Brazil, were included in this study. Cell-in-cell structures were evaluated on surgical postoperative sections that stained with hematoxylin and eosin staining.ResultsWe found that cell-in-cell structures associated with cancer-related mortality in univariable analysis with a hazard ratio (HR) of 2.99 (95%CI 1.52-5.88; P=0.001). This association was confirmed in multivariable analysis (HR 2.22, 95%CI 1.12-4.44; P=0.024). In addition, statistically significant associations were observed between the cell-in-cell structures and other adverse histopathologic characteristics including deep invasion (P<0.001), high index of tumor budding (P=0.007), worst pattern of invasion (P<0.001), perineural invasion (P=0.01), and stroma-rich pattern (P=0.001).ConclusionsOur findings demonstrate a significant relationship between cell-in-cell formation and aggressive characteristics of early OTSCC. Cell-in-cell structures have a distinct impact as a novel prognostic indicator in early OTSCC and they can be easily assessed during routine pathology practice.Peer reviewe