[Sinonasal mucosal melanoma]

Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and agresive neoplasms and carries a bad prognosis. The diagnosis may require confirmatory immunohistochemical stains (S-100 protein, HMB-45, vimentin and cytokeratine). The clinical records of 6 patients with the diagnosis of sinonasal melanomas between 1991 and 2005 were retrospectively reviewed. The mean age was 70 years (range 51 to 83 years), there were 2 men and 4 women. Surgery was performed in four patients, adjuvant radiation therapy was used in one patient after local recurrence and chemotherapy in three patients. Three of four patients (75%) had a recurrence after previous treatment (surgery). The actuarial disease-free survival for this group of 6 is 33.3% (2 of 6). Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis.

[Cutaneous melanoma of the head and neck]

The clinical records of 20 patients with the diagnosis of cutaneous melanoma of the head and neck treated between 1991 and 2005 were retrospectively reviewed. Advances in diagnostic techniques and treatment have had obvious impact on outcomes in cutaneous melanoma. Cutaneous melanoma of the head of neck is treated with complete surgical resection in early stage disease. Resection margins are determined by the size and depth. Evaluation for regional and distant metastatic disease is necessary in advanced stage disease. Adjuvant therapy may be indicated in regional nodal disease.

[Metastasis to the parotid gland]

INTRODUCTION

Metastatic disease in the parotid gland has been observed and reported in the literature, and its treatment is controversial.

MATERIAL AND METHODS

We review 48 patients with parotid tumors that underwent surgery during 1997-2004. The clinical and histogical features are reviewed.

RESULTS

Among these 48, there were 12 cases of metastatic tumors to the parotid (25%). The pathohistological analysis of these tumors revealed that 8 were epidermoid carcinoma (66%), 1 patient was a melanoma (8%), 2 lymphomas below clavicules (16%) and 1 patient with a metastasis of a primary renal cancer. All patients underwent parotidectomy and 10 also cervical neck dissection (6 cases showed cervical metastases). 8 patients received radiotherapy after surgery.

CONCLUSIONS

In our study parotid metastases are relatively common in patients submitted for parotid surgery. Often the site of origin of the primary tumor is the facial skin, and the primary tumors most commonly are melanomas or squamous-cell carcinomas, but it is possible distant primary tumors below clavicules.

[Postseptal orbital cellulitis and sinusitis. Descriptive study of 8 cases and literature review]

This is a retrospective study of 8 patients with postseptal orbital cellulitis (stages II-V of Chandler) caused by sinusitis during 1999-2003. The variables analyzed in this study included age, sex, delay in diagnosis, aetiology, imaging studies, microbiology specimens collected and treatment. Delays in diagnosis were frecuent. CT was the best radiologic study. Polymicrobial infections were the rule, including anaerobes. 4 patients of 8 needed surgical drainage. A general guideline for the management of periorbital and orbital cellulitis according to the clinical staging of the process is presented.

Indicadores bioquímicos predictivos de fístula faringocutánea postlaringuectomía: un estudio clínico

The aim of this clinical study was to determinate biochemical predictor indicators of postlaryngectomy pharyngocutaneous fistula.

PATIENTS AND METHODS

We have studied 100 patients with T2- 4 a laryngeal and piryform sinus carcinoma who underwent a laryngectomy. All patients were ASA 2-3. We studied serum albumin, protein serum level, cholesterol and lymphocites in each patient. These variables underwent statistical analysis (p < 0.05).

RESULTS

19% of the patients developed a postlaryngectomy pharyngocutaneous fistula, with a long-stay of 25 days vs. 10 days of stay in patients without postlaryngectomy pharyngocutaneous fistula. 7 postlaryngectomy pharyngocutaneous fistula needed surgical repair. Low serum albumin (< 3.5 g/dL) and a low level of serum proteins (< 6.5 g/dL) were predictive indicators of postlaryngectomy pharyngocutaneous fistula (p < 0.05).

CONCLUSIONS

Our results suggest that a low-level of serum proteins and albumin are predictive clinical parameters of postlaryngeal pharyngocutaneous fistula.

Manifestaciones otológicas en la enfermedad de Fabry-Anderson

Anderson-Fabry disease in an inherited X-linked metabolic disorder involving glycosphingolipid metabolism. Few data are available regarding cochlear involvement. Clinical manifestations of Fabry disease appeared on the first decade of life. The prognosis of males with Fabry disease is serious and life expectancy is limited; clinical evolution of heterozygous females is clearly better. We report a family with Fabry disease in several members. The mother, already dead, had two child which have been examined in our department; the male, without a risk of ototoxicity, or acoustic trauma, has progressive hearing loss, tinnitus and dizinness sometimes; the daughter, without a history of deafness, shows unilateral hearing loss on high-tone frequencies. It is important to emphasize these data to those physicians expert in children with Fabry disease because early enzyme replacement therapy intervention should offer increased possibilities of regression of the disease.

Cirugía mínimamente invasiva para el tratamiento de la sinusitis fronto-etmoidal complicada

OBJECTIVES

Functional endoscopic sinus surgery (FESS) is nowadays the "gold standard" for frontal sinus pathologies, but management of acute situations and the aproach and/or the extent of the surgery perfomed in the frontal recess remains controversial nowadays.

MATERIAL AND METHODS

We report our experience in 4 patients with orbital celulitis due to frontal sinusitis who underwent combined external surgery (mini-trephination) and endoscopic sinus surgery.

RESULTS

All patients managed sinus patency without any complications.

CONCLUSIONS

We found this combined sinusotomy as an easy, effective and reproductible technique in order to resolve the difficult surgical management of complicated frontal sinusitis.

Chromosome 3p loss of heterozygosity and mutation analysis of the FHIT and beta-cat genes in squamous cell carcinoma of the head and neck

AIMS

To study the loss of heterozygosity at the short arm of chromosome 3 in primary tumours from patients with squamous cell carcinoma of the head and neck; to determine whether the FHIT gene, mapped to 3p14.2 and the CTNNB1 (beta-cat) gene, mapped to 3p21, are deleted or mutated in these tumours.

METHODS

DNA was extracted from fresh tumours. Loss of heterozygosity was assessed by microsatellite analysis of the following markers: D3S1283 and D3S1286 (3p24), D3S966 (3p21), and D3S1300 (3P14.2). Homozygous deletion was determined by radioactive multiplex polymerase chain reaction of exons 5 and 6 of the FHIT gene. The presence of mutations in FHIT exon 5 and beta-cat exon 3 was studied by single strand conformation polymorphism.

RESULTS

50% of informative cases (25/50) showed loss of heterozygosity for at least one of the 3p markers. 3p21 was the region with the highest rate of allelic deletion (63%). No point mutation was found in FHIT exon 5 or beta-cat exon 3. No case showed homozygous deletion for the FHIT (exons 5 and 6) or the beta-cat exon 3.

CONCLUSIONS

The short arm of chromosome 3 is often deleted in the head and neck squamous cell carcinomas. In the remaining alleles of the FHIT or beta-cat genes, no evidence was found for point mutations or deletions, documented in other common carcinomas. Inactivation could occur by different mechanisms such as methylation, or other genes (not studied here) could be target of allelic losses in squamous cell carcinoma of the head and neck.

Genetic polymorphism of N-acetyltransferase-2, glutathione S-transferase-M1, and cytochromes P450IIE1 and P450IID6 in the susceptibility to head and neck cancer

AIMS

To analyse the allele frequencies of DNA polymorphisms at the genes for cytochromes P450IIE1 and P450IID6, N-acetyltransferase-2, and glutathione S-transferase-M1 in patients with head and neck squamous cell carcinoma, in an attempt to define genetic factors involved in the susceptibility to this cancer, which is strongly associated with tobacco consumption.

METHODS

Determination of restriction fragment length polymorphism (RFLP) at cytochromes P450IIE1/P450IID6 and NAT2 genes, and the presence of homozygous deletion of the GSTM1 gene, in 200 controls and 75 head and neck cancer patients. Allelic frequencies between the two groups were compared using a chi 2 test, and odds ratio with 95% confidence intervals were calculated.

RESULTS

There was no evidence of an association between alleles of CYP2D6 and CYP2E1 and head and neck cancer in our population. Similarly, frequencies of individuals lacking the GSTM1 gene did not differ between controls and patients. However, individuals with the NAT2-SA phenotype were at higher risk of developing head and neck cancer. The frequencies of the most common SA genotype (homozygous for the NAT2*5 allele) were higher in patients than in controls (27% v 15%, respectively). Slow acetylators homozygous for the NAT2*6 allele, the second most common SA allele, were also more common in patients than in controls (11% v 5%, respectively).

CONCLUSIONS

Slow NAT2 activity is a risk factor possibly leading to the development of head and neck cancer in response to tobacco carcinogens.

Deletion and methylation of the tumour suppressor gene p16/CDKN2 in primary head and neck squamous cell carcinoma

AIMS

To study the homozygous deletion and methylation status of the 5' CpG island of the p16 and p15 genes (9p21) in a set of primary advanced head and neck squamous cell carcinomas (SCC) and to test whether inactivation of these genes by these mechanisms contributes to head and neck SCC development.

METHODS

DNA was extracted from fresh tumours. Homozygous deletion was determined by the polymerase chain reaction (PCR) followed by hybridisation with the corresponding probe, radioactively labelled by the random priming method. Methylation status of the CpG island of the 5' region of these genes was assessed by digestion with the appropriate restriction enzymes followed by PCR and subsequent hybridisation with the corresponding probe. The presence of point mutations was determined by PCR-SSCP (single strand conformation polymorphism).

RESULTS

The p16 and p15 genes were homozygously deleted in 20% and 10% of the tumours, respectively. No point mutations were found at p16 and p15. The 5' CpG island at the p16 gene was methylated in 20% of the cases.

CONCLUSIONS

The tumour suppressor gene p16 is inactivated through homozygous deletion or methylation in a significant proportion of cases of head and neck SCC.

Loss of heterozygosity and mutation analysis of the p16 (9p21) and p53 (17p13) genes in squamous cell carcinoma of the head and neck

We analyzed allelic loss at the p53 gene (17p13) and at chromosome region 9p21 in 35 primary head and neck squamous cell carcinomas. Loss of heterozygosity (LOH) at p53 and 9p21 was found in 50 and 75% of informative cases, respectively. LOH at the p53 gene did not increase significantly with tumor stage, but was more frequent in moderately and poorly differentiated tumors than in well-differentiated tumors. LOH plus mutation or homozygous deletion of p53 was limited to advanced stage and poorly differentiated tumors. Allelic loss at 9p21 is frequent in early stage head and neck squamous cell carcinoma and is not significantly associated with LOH at p53. The second exon of the p16/MTS1/CDKN2 gene was found to be homozygously deleted in 1 of 19 cases showing LOH at 9p21, but direct sequencing did not show mutations in the remaining 18 cases. This suggests that p16 plays a limited role in the development of head and neck squamous cell carcinoma.

[Nasal endoscopic surgery in complicated ethmoiditis]

Spread of infection from paranasal sinuses is uncommon but, when it occurs may lead to serious ocular or intracranial complications. In this article we present four patients, three of them with orbital complications and one with an intracranial abscess, who were successfully treated with endoscopic surgery of the sinuses and antibiotic therapy. We describe some potential advantages of this approach.

[Clinicopathologic prognostic factors of laryngeal and pharyngeal tumors. III: Supraglottic carcinoma]

The factors which influenced the prognosis of 306 supraglotic carcinomas were studied. The determinate survival at 3 and 5 years was 7.8% and 57.5% respectively. The lymph node metastases and the presence of recurrence affected significantly the survival. Also showed a worse prognosis those with an advanced local stage, and the patients with excessive alcoholic consumption. Without significative prognostic influence were the grade of tumor differentiation, involvement of surgical margins, previous tracheostomy, and the existence of a second primary tumour.