Clinical and histopathological analysis of parotid gland tumors

Orientadores: Luiz Paulo Kowalski, Oslei Paes de AlmeidaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Os tumores de glândulas salivares são raros, registrando-se cerca de 0,4 a 13,5 casos por 100000 pessoas por ano. A maioria desses tumores acometem a glândula parótida, representando de 64% a 80% dos casos, com predomínio de tumores benignos. Os objetivos deste trabalho foram avaliar as principais características clínicas e histopatológicas de tumores de parótida, selecionando todos os pacientes com tumor primário de parótida atendidos no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital A. C. Camargo de São Paulo, entre 1953 e 2003. Os pacientes já tratados previamente em outra instituição ou com falta de informações clínicas ou histológicas nos prontuários hospitalares foram excluídos deste estudo. Um total de 600 casos foram selecionados, sendo 369 benignos e 231 malignos. Dentre os tumores benignos o adenoma pleomorfo foi o mais comum, correspondendo a 66,5% dos casos seguido pelo Tumor de Warthin com 25%. Dos malignos o mais comum foi o carcinoma mucoepidermóide. Dezenove casos (3,16%) correspondiam a tumores mesenquimais não linfóides, sendo 15 benignos e 4 malignos. A principal modalidade de tratamento para os tumores de parótida, tanto benignos como malignos, foi a ressecção cirúrgica, incluindo parotidectomias parciais, totais ou ampliadas. Em alguns casos de tumores malignos, terapias adjuvantes, principalmente a radioterapia, foram aplicadas. Os índices de recorrência local, regional e à distância dos tumores malignos foram de 10%, 8% e 9%, respectivamente. A análise multivariada indicou que a invasão clínica da pele, disfunção do nervo facial e o crescimento perineural foram os fatores mais significativos para a sobrevida livre de doença dos pacientes com carcinomas de parótida. Testando dois scores de prognóstico previamente publicados por Vander Poorten et al. (1999) e Carrillo et al. (2007), observamos uma melhor distinção do grupo de pacientes com pior prognóstico, e o melhor score foi o apresentado por CarrilloAbstract: Salivary gland tumors are rare, with an annual incidence of about 0,4 to 13,5 cases per 100000 people. Most of the cases affect the parotid gland, representing 64% to 80% of the cases and the majority is benign. The aim of this study was to analyze the main clinical and histopathological features of parotid gland tumors. We select all the patients with primary parotid tumors referred to the Department of Head and Neck Surgery and Otorhinolaryngology from A. C. Camargo Hospital from 1953 to 2003. The patients previously treated at another institution or with incomplete histological or clinical information were excluded. A total of 600 cases were selected, being 369 benign and 231 malignant. Pleomorphic adenoma was the most frequent benign tumor, corresponding to 66,5% of the cases followed by Warthin tumor with 25%. From the malignant tumors, the most common was the mucoepidermoid carcinoma. Nineteen cases (3,16%) were nonlymphoid mesenchymal tumors, being 15 benign and 4 malignant. The main treatment modality for the parotid tumors was the partial, total or extended parotidectomy. In some malignant cases, adjuvant therapies, mainly radiotherapy, were applied. The incidence of local, regional and distant recurrences were 10%, 8% e 9%, respectively. The multivariate analysis indicated clinical skin invasion, facial nerve dysfunction and perineural growth as the most significant recurrent disease-related prognostic factors for patients with parotid carcinoma. Testing two prognostic scores previously published by Vander Poorten et al. (1999) and Carrillo et al. (2007), the group with worse prognosis can be well characterized using both scores, but the best prognostic score was the presented by CarrilloDoutoradoSemiologiaDoutor em Estomatopatologi

Lipoma De Células Fusiformes Intraoral Com Diferenciação Condroide: Importância No Diagnóstico De Lesões Orais Contendo Tecido Cartilaginoso

Lipomas are benign neoplasms of adipose tissue presenting several histologic variants, which can be rarely found in the oral cavity. We present a case of a 62-year-old woman with a submucous nodule located in the tongue. Histopathological examination revealed an encapsulated tumor composed of myxoid tissue, spindle cells and mature adipocytes in transition to cartilaginous tissue. The final diagnosis was spindle-cell lipoma with myxoid change and chondroid differentiation. No sign of recurrence was found after five years. The diagnosis of intraoral mesenchymal lesions with chondroid differentiation requires careful histologic examination, mainly to differentiate between benign and malignant lesions.52318919

Oral Manifestation as the Main Sign of an Advanced Stage Acute promyelocytic Leukemia

Akutna mijeloična leukemija agresivna je maligna neoplazma koja se uglavnom pojavljuje kod starijih osoba u dobi od 65 godina. Oralne manifestacije i najčešće spontano krvarenje uobičajeni su nalazi u slučaju te bolest i mogu upućivati na početnu fazu. U ovom izvještaju opisan je slučaj 47-godišnjeg muškarca s jednomjesečnim spontanim oralnim krvarenjem. Pacijent je već prije zatražio mišljenje dvaju profesionalaca, ali bez ikakva rezultata. Fizikalni pregled pokazao je bljedoću, vrućicu, krvarenje iz nosa (epistaxis) i ekhimoze u oralnoj sluznici. Kompletna krvna slika upućivala je na anemiju, tešku trombocitopeniju i leukocitozu sa skretanjem KS-a ulijevo, pojačavajući tako dijagnozu hipoteze akutne leukemije. Pacijent je odmah prevezen u bolnicu i unatoč tomu što mu je pružena hitna pomoć, umro je tri dana poslije zbog difuznoga plućnog alveolarnog krvarenja. Na uzorku periferne krvi bila je obavljena imunofenotipizacija i dobivena je dijagnoza hipogranularne inačice akutne promijeloične leukemije. Kašnjenje u postavljanju dijagnoze moglo je utjecati na nepovoljan ishod. Rana dijagnoza i liječenje prijeko su potrebni za preživljavanje pacijenata s leukemijom pa su i doktori dentalne medicine odgovorni za rano otkrivanje oralnih manifestacija leukemije i za brzo upućivanje pacijenta odgovarajućem stručnjaku.Acute myeloid leukemia is an aggressive malignant neoplasm occurring mainly in elderly, with the median age of 65 years. Oral manifestations, mainly spontaneous bleeding, are a common finding in acute myelocytic leukemia and may represent the initial evidence of the disease. This report describes a case of a 47-year-old man with a one-month history of spontaneous oral bleeding. The patient had already been consulted by two professionals but he remained undiagnosed. The physical examination revealed paleness, fever, epistaxis and ecchymoses in the oral mucosa. The complete blood count revealed anemia, severe thrombocytopenia and leukocytosis with blasts predominance, reinforcing the diagnosis hypothesis of an acute leukemia. The patient was immediately referred to the Hospital and despite having received a quick intervention, he died 3 days after the admission due to diffuse pulmonary alveolar hemorrhage. According to the peripheral blood immunophenotyping the diagnosis of hypogranular variant of acute promyelocytic leukemia was established. The delay in the diagnosis may have influenced the unfavorable outcome. Early diagnosis and management are indispensable for survival of leukemia patients. In this way, dentists may be responsible for an early detection of oral manifestations of leukemia and for a fast referral to an adequate professional

Parotid neoplasms: analysis of 600 patients attended at a single institution Neoplasias de parótida: análise de 600 pacientes atendidos em uma única instituição

Salivary gland tumors are rare, generally benign and affect mainly the parotid gland. AIM: The purpose of this study was to retrospectively analyze all cases of parotid tumors treated at our institution from 1953 to 2003. METHODS: All patients with primary parotid tumors were selected; clinical and histopathological data were analyzed and described. RESULTS: 600 cases of parotid tumors were selected; 369 were benign and 231 were malignant. Pleomorphic adenoma was the most frequent benign tumor. The most common malignant tumor was the mucoepidermoid carcinoma. Therapy in most cases consisted of parotidectomy. Adjuvant therapy - mainly radiotherapy - was used in some cases with malignant tumors. The incidences of local, regional and distant recurrences of malignant tumors were 10%, 8% and 9%. CONCLUSION: Patients with parotid tumors treated at our institution were mainly adults, with marginally more female patients. Benign tumors were mostly the pleomorphic adenoma, which were more frequent than malignancies. Most of the patients were treated by partial or total parotidectomy. Adjuvant therapy, mainly radiotherapy, was used in selected malignant cases.<br>Os tumores de glândula salivar são raros e acometem principalmente a parótida, sendo a maioria de natureza benigna. OBJETIVOS: Avaliar todos os casos de tumor de parótida atendidos na nossa instituição, durante o período de 1953 a 2003. Estudo Retrospectivo. CASUÍSTICA E MÉTODOS: Todos os pacientes com tumores primários de parótida foram selecionados e os dados clínicos e histopatológicos foram analisados e descritos. RESULTADOS: Foram selecionados 600 casos, sendo 369 benignos e 231 malignos. Dentre os tumores benignos, o adenoma pleomorfo foi o mais comum, e dentre os malignos, o carcinoma mucoepidermoide. A principal modalidade de tratamento foi a parotidectomia e em alguns casos malignos, terapias adjuvantes, principalmente a radioterapia, foram aplicadas. Os índices de recorrência local, regional e à distância dos tumores malignos foram de 10%, 8% e 9%, respectivamente. CONCLUSÕES: O perfil dos pacientes com tumor de parótida foi formado predominantemente por adultos e discreta predileção pelo gênero feminino. Os tumores benignos foram os mais frequentes. A maioria dos pacientes foram tratados por parotidectomia parcial ou total. O uso de terapias adjuvantes, principalmente a radioterapia, foi reservada para casos específicos de tumores malignos

Parotid Neoplasms: Analysis Of 600 Patients Attended At A Single Institution.

Salivary gland tumors are rare, generally benign and affect mainly the parotid gland. The purpose of this study was to retrospectively analyze all cases of parotid tumors treated at our institution from 1953 to 2003. All patients with primary parotid tumors were selected; clinical and histopathological data were analyzed and described. 600 cases of parotid tumors were selected; 369 were benign and 231 were malignant. Pleomorphic adenoma was the most frequent benign tumor. The most common malignant tumor was the mucoepidermoid carcinoma. Therapy in most cases consisted of parotidectomy. Adjuvant therapy -- mainly radiotherapy -- was used in some cases with malignant tumors. The incidences of local, regional and distant recurrences of malignant tumors were 10%, 8% and 9%. Patients with parotid tumors treated at our institution were mainly adults, with marginally more female patients. Benign tumors were mostly the pleomorphic adenoma, which were more frequent than malignancies. Most of the patients were treated by partial or total parotidectomy. Adjuvant therapy, mainly radiotherapy, was used in selected malignant cases.75497-50