Demographic and clinicopathologic distribution of head and neck malignant tumors in pediatric patients from a brazilian institution : a retrospective study

Orientador: Alan Roger dos Santos SilvaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Mundialmente, o câncer representa uma das principais causas de morte entre crianças. A despeito do aprimoramento das modalidades de tratamentos do câncer, sua incidência continua a aumentar no âmbito da pediatria. Neste contexto, estudos demostraram que o câncer de cabeça e pescoço (CCP) corresponde a 12% dos casos; representado uma das topografias mais frequentemente afetadas pelo câncer pediátrico. Ademais, a literatura internacional relata que a região de cabeça e pescoço de pacientes pediátricos pode ser acometida por uma miríade de tumores malignos incluindo linfomas, rabdomiossarcomas, neuroblastomas, carcinomas de tireoide e de nasofaringe. Embora se reconheça que a frequência do CCP é influenciada por uma série de variáveis demográficas dos pacientes pediátricos, estudos epidemiológicos sobre o perfil clinicopatológico dos pacientes afetados por CCP na infância são escassos e, até o momento, não existem dados publicados em veículos científicos internacionais sobre esta problemática em pacientes da América Latina. Portanto, o objetivo deste estudo foi descrever a distribuição demográfica e clinicopatológica dos tumores malignos de cabeça e pescoço em pacientes de um centro brasileiro de referência no diagnóstico e tratamento do câncer infantil. Com essa finalidade, foram revisados retrospectivamente os prontuários médicos dos pacientes pediátricos (0 a 19 anos) diagnosticados com tumores malignos na região de cabeça e pescoço no Centro Infantil Boldrini, em Campinas (SP), registrados no período entre 1986 a 2016. Os diagnósticos anatomopatológicos e a localização dos tumores; o gênero, a idade e a raça dos pacientes foram as variáveis analisadas. Retinoblastomas e tumores do sistema nervoso central foram excluídos das análises deste estudo. No período de 30 anos, o CCP representou 5,11% de todas as malignidades; os tipos de câncer mais comuns foram linfomas, seguido de carcinomas e sarcomas. O linfoma de Burkitt, o linfoma de Hodgkin clássico tipo esclerose nodular, o carcinoma nasofaríngeo e o rabdomiossarcoma foram os diagnósticos histopatológicos mais comuns. Os principais sítios anatômicos afetados foram a região cervical e linfonodos, a nasofaringe e a glândula tireoide. A média de idade dos pacientes no momento do diagnóstico foi de 9,35 anos e os pacientes na faixa etária entre 10 a 14 anos apresentaram maior prevalência de tumores malignos. Foi identificada predominância pelo gênero masculino (65,67%) e pela raça branca (73,02%). Em suma, o presente estudo apresenta dados originais acerca do perfil demográfico e clinicopatológico de pacientes brasileiros pediátricos com CCP e sugere que os linfomas foram mais frequentes do que carcinomas e sarcomasAbstract: Worldwide, cancer represents one of the main causes of death among children. Despite the improvement in cancer treatments modalities, its incidence continues to increase in the pediatric field. In this context, some studies showed that head and neck cancer (HNC) corresponds to 12% of cases; representing one of the most frequently topographies affected by pediatric cancer. In addition, the international literature reports that the head and neck region in pediatric patients may be affected by a myriad of malignant tumors including lymphomas, rhabdomyosarcomas, neuroblastomas, thyroid carcinoma and nasopharyngeal carcinomas. Although it is known that the HNC frequency is influenced by a series of demographic variables in pediatric patients, epidemiological studies on the clinicopathological profile of HNC patients in childhood are scarce and, to date, there are no published data in the international literature regarding Latin American patients. Therefore, the aim of this study was to describe the demographic and clinicopathological distribution of malignant head and neck tumors in patients from a Brazilian reference center in the diagnosis and treatment of childhood cancer. Hence, the medical records of pediatric patients (0 to 19 years old) diagnosed with malignant tumors in the head and neck region of the Boldrini Children's Center, Campinas (SP), were registered retrospectively between 1986 and 2016. Variables such as histopathological diagnoses and the location of the tumors; gender, age and patient race were analyzed. Retinoblastomas and tumors of the central nervous system were excluded from analysis of the current study. In a 30 years period, the HNC represented 5.11% of all malignancies; lymphomas were the most common type of cancer, followed by carcinomas and sarcomas. Burkitt lymphoma, nodular sclerosis Hodgkin lymphoma, nasopharyngeal carcinoma, and rhabdomyosarcoma were the most common histopathological diagnoses. The main anatomical sites affected were the cervical region and lymph nodes, the nasopharynx and the thyroid gland. At the moment of diagnosis, the mean age of the patients was 9.35 years, and the group aged from 10 to 14 years had a higher prevalence of malignant tumors. It was identified a slight predominance on male (65.67%) and white (73.02%) patients. In summary, the present study showed original data about the demographic and clinicopathological profile of Brazilian pediatric patients with HNC, and suggested that lymphomas are more frequent than carcinomas and sarcomasMestradoPatologiaMestra em Estomatopatologia33003033009P4CAPE

Intraoral EBV-positive sporadic Burkitt lymphoma in an elderly patient with bilateral presentation

Sporadic Burkitt lymphoma (SBL) is a variant of Burkitt lymphoma that occurs worldwide, affecting mainly children and young adults. Association with Epstein-Barr virus (EBV) can be identified in approximately 20-30% of cases. Herein we described a case of a 63-year-old male presenting intraoral bilateral mandibular swelling, subjacent to fixed dental prosthesis, with one month of duration. Incisional biopsies were performed, and after two days, the patient was hospitalized due to malaise and breathing difficulty, and died after a week when an abdominal tumor was detected. The mandibular biopsies revealed a diffuse proliferation of medium-sized monomorphic atypical lymphoid cells exhibiting numerous mitoses and areas of “starry-sky” pattern. The tumor showed immunohistochemical positivity for CD20, CD10, Bcl-6, and Ki-67 (≈ 100%); it was negative for CD3, Bcl-2, Vs38c, and MUM-1. Positivity for EBV was found by in situ hybridization. The final diagnosis was intraoral SBL positive for EBV. Clinical, morphological and molecular criteria are necessary for the correct diagnosis of aggressive B-cell neoplasms positive for EBV in elderly patients

Squamous cell carcinoma of the oral cavity, oropharynx, and larynx: a scoping review of treatment guidelines worldwide

Head and neck cancer (HNC) treatments have been based on single or multimodal therapies with surgery, radiotherapy (RT), chemotherapy, and immunotherapy. However, treatment recommendations among countries may differ due to technological/human resources and usual local practices. This scoping review aims to identify, compare, and map the clinical practice guidelines (CPGs) for treating squamous cell carcinoma (SCC) of the oral cavity, oropharynx, and larynx worldwide. A search strategy on global CPGs for HNC was performed by using five electronic databases and grey literature. CPGs were selected for inclusion using EndNote-20 and Rayyan online software. No language or publication date restrictions were applied. The results were analyzed descriptively considering the most updated CPG version. In total, 25 CPGs covering the head and neck region (10), the larynx (7), the oral cavity (5), and the oropharynx (3), were found in 13 geographical regions, and 19 were developed by medical societies from 1996 to 2023. Surgery and RT remain the main modalities for early-stage HNC, with surgery preferred in low-resource countries, and RT in selected cases, especially in the larynx/oropharynx aiming to achieve a cure with organ preservation. Human papillomavirus infection for oropharyngeal SCC is not tested in some Asian countries and there is still no consensus to treat p16-positive cases differently from p16-negative. Recommendations for larynx preservation vary according to facilities in each country, however, individualized choice is emphasized. Inequality across countries/continents is evident, with a similar pattern of recommendations among developed as well as developing ones. No CPGs were found in Latin America as well as Oceania countries, where the incidence of HNC is high and limitations of access to treatment may be encountered

Squamous Cell Carcinoma of the Oral Cavity, Oropharynx, and Larynx: A Scoping Review of Treatment Guidelines Worldwide

Treatment recommendations for head and neck cancer need to be disseminated worldwide becoming available through societies/authors scientific reports and websites with warning updates. This scoping review identifies and compares the worldwide clinical practice guidelines for treating oral, oropharynx, and larynx cancer. We verified the absence of guidelines in Latin American and Oceanian countries, as well as the inequalities between countries/continents, with a similar pattern of recommendations among low-income countries and in developed ones. Recommendations for surgery, radiotherapy, and chemotherapy may differ according to country/institution access and resource

Massive extrusion of calcium hydroxide paste containing barium sulphate during endodontic treatment

A 31‐year‐old woman was referred for the evaluation of persistent lower lip numbness following endodontic treatment of tooth #36. Imaging examinations showed a large amount of radiopaque/hyperdense material spread in an angiographic distribution in the left mandibular body region. Laboratory analyses of tooth #36 and adjacent periapical tissue, surgically extracted in an external Service due to acute pain following endodontic treatment, identified chronic inflammatory reaction and birefringent crystalloid foreign bodies rich in barium and sulphur, leading to the diagnosis of alveolar nerve injury due to accidental extrusion of intracanal dressing material composed of calcium hydroxide [Ca(OH)2] paste incorporated with barium sulphate. Clinicians should be aware that Ca(OH)2 when in contact with periapical tissues may lead to persistent toxicities, such as necrosis, pain and paraesthesia. Therefore, injectable Ca(OH)2 systems should be used with caution because they can cause paste extrusion and damage to the lower alveolar nerveCONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESNão tem758/2012The authors would like to thank the Coordination for the Improvement of Higher Education Personnel (CAPES/PROEX process number 758/2012) as well as the National Council for Scientific and Technological Development, CNPq, Brazil. The authors also thank Adriano Luis Martins who provided technical support in scanning electron microscopy and contributed to the experimental investigation of the current cas

Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022

Abstract Background The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision‐making about this treatment according to the tumor site, clinical stage, and patient medical status. Aim The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period. Methods and Results Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta‐analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early‐stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised. Conclusion NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non‐surgical techniques. The guidelines support decision‐making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences

Tumor safety and side effects of photobiomodulation therapy used for prevention and management of cancer treatment toxicities : a systematic review

Photobiomodulation therapy (PBMT), also known as low-level laser therapy (LLLT), has been increasingly used for the treatment of toxicities related to cancer treatment. One of the challenges for the universal acceptance of PBMT use in cancer patients is whether or not there is a potential for the light to stimulate the growth of residual malignant cells that evaded oncologic treatment, increasing the risk for tumor recurrences and development of a second primary tumor. Current science suggests promising effects of PBMT in the prevention and treatment of breast cancer-related lymphedema and oral mucositis, among other cancer treatment toxicities. Nevertheless, this seems to be the first systematic review to analyze the safety of the use of PBMT for the management of cancer-related toxicities. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 27 articles met the search criteria. Selected studies included the use of PBMT for prevention and treatment of oral mucositis, lymphedema, radiodermatitis, and peripheral neuropathy. Most studies showed that no side effects were observed with the use of PBMT. The results of this systematic review, based on current literature, suggest that the use of PBMT in the prevention and management of cancer treatment toxicities does not lead to the development of tumor safety issues932128CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão tem2018/02233-6; 2018/04657-