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Biomedical subjects

Adalberto Mosqueda-Taylor

Publications and source records attributed to Adalberto Mosqueda-Taylor.

At least 19 recordsLinked to original sources

Supracricoid partial laryngectomy as a primary treatment for carcinosarcoma of the larynx.

Carcinosarcoma of the larynx is uncommon. When it does occur; its clinical features resemble those of sarcomatoid carcinoma, and its biologic behavior is similar to that of malignant mesenchymal neoplasms. We describe 2 cases of carcinosarcoma of the glottis. The tumors were staged as T3N0M0 and T2N0M0. Both patients were treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Eight months postoperatively, 1 of the 2 patients experienced a recurrence of the sarcomatous component of the tumor, and he underwent a total laryngectomy. The other patient remained free of disease at 12 months of follow-up. We conclude that supracricoid partial laryngectomy may be offered as an organ-preserving measure even in patients with sarcomatous disease; total laryngectomy can be held in reserve as a rescue measure. Patients must be closely monitored for early detection of recurrence. The role of adjuvant therapy for sarcomatous neoplasms in this area has not yet been clearly established.

Carcinosarcoma↗

Free osseous and soft tissue surgical margins as prognostic factors in mandibular osteosarcoma.

Osteosarcoma is an infrequent, locally aggressive neoplasm in the head and neck region. To date, surgery is the mainstay of treatment. However, patients with mandibular osteosarcomas usually have a locally advanced disease at diagnosis and therefore represent a therapeutic challenge because surgical margins are difficult to obtain due to aesthetic and functional concerns. To evaluate possible prognostic factors implicated in recurrence, persistence or relapse in osteosarcoma of the mandible, with special reference to the soft tissue and bone surgical margins. A series of 20 patients with mandibular osteosarcomas treated at the Instituto Nacional de Cancerología (México) from 1985 to 1999 are reviewed. There were 14 female and 6 male patients. Twelve cases were treated with surgery alone, 3 patients with surgery and adjuvant radiotherapy, 1 had neoadjuvant chemotherapy followed by surgery, 1 had neoadjuvant chemotherapy, surgery and postoperative radiotherapy, 1 with surgery and adjuvant chemotherapy, 1 with surgery followed by adjuvant chemotherapy and radiotherapy and one patient rejected treatment. Between 1985 and 1992 these neoplasms were treated by means of total mandibulectomy, independently of tumor size, but between 1993 and 1999 the policy was to practice smaller resections but long enough to obtain macroscopic surgical free margins. In the first period the relationship between mandibular size resection and tumor size was 1.9, meanwhile in the second period the relation was 1.5. There was not significant difference between both periods in terms of tumor size (6.0 cm vs. 6.02 cm at the time of surgery) nor in local control and survival. Soft tissue involvement as reported by histological study was strongly associated with recurrence (p = 0.0024). Overall 5-year survival was 20%. A policy of total mandibulectomy is not associated with a better local control or survival. Extent of resection must be tailored with tumor size. Extent of margins in soft tissue is the limiting factor for local control.

Adolescent↗

Clinicopathological and immunohistochemical study of 39 cases of Adenomatoid Odontogenic Tumour: a multicentric study.

Adenomatoid Odontogenic Tumour (AOT) is a relatively uncommon odontogenic lesion and few studies describing its cytokeratin profile have been reported in the English-language literature. Thirty-nine cases of AOT from three Oral Diagnosis services (Brazil, Mexico and Guatemala) were studied, considering their clinical, radiographic, and histological features and immunohistochemical expression of cytokeratins (AE1/AE3, 34betaE12, CK1, CK5, CK6, CK7, CK8, CK10, CK13, CK14, CK16, CK18, and CK19), vimentin and Ki-67. Sixty five percent of cases affected women, anterior maxilla was the preferred site and radiographically most cases showed unilocular radiolucency with well defined sclerotic borders. Calcifying epithelial odontogenic tumour (CEOT)-like areas were found in 36 out of 39 cases, and 10 cases showed positivity for Congo red in polarized light. All cases were positive for AE1/AE3, 34betaE12, CK5, CK14 and CK19. CEOT-like areas were negative for CK 19. Vimentin was also expressed in 27 cases and this profile may indicate the existence of a variable phenotype in certain areas of the tumour. There were no recurrences after surgical treatment, and this can be related to the low proliferative activity observed in all cases with Ki-67 marker.

Adolescent↗

Association of HLA-DR4 (DRB1*0404) with human papillomavirus infection in patients with focal epithelial hyperplasia.

OBJECTIVES: To determine gene frequencies of HLA-DR alleles in 22 Mexican patients with focal epithelial hyperplasia and compare them with those present in ethnically matched healthy subjects, as well as to determine the types of human papillomavirus present in the lesions. DESIGN: Prospective and retrospective observational study. SETTING: Dermatology outpatient clinic in a general hospital. PATIENTS: Twenty-two patients with clinically and histologically confirmed focal epithelial hyperplasia seen within a 10-year period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Results of high-resolution DNA typing for HLA-DR alleles and biopsy for viral typing. RESULTS: HLA-DR4 (DRB1*0404) was significantly increased (P<.001; odds ratio, 3.9; 95% confidence interval, 1.86-8.03). Seventeen (85%) of 20 patients had human papillomavirus subtype 13. The data on human papillomavirus differed from reports elsewhere that described association with human papillomavirus type 32. CONCLUSIONS: The HLA-DRB1*0404 allele suggests that Amerindian populations are at risk, and in this group, the Mexican population studied was affected only by human papillomavirus type 13.

Adolescent↗

Frey syndrome. A proposal for evaluating severity.

We aimed to establish the incidence of Frey's syndrome in patients that have been submitted to partial and total parotidectomy at a cancer-treating hospital in Mexico City and to propose a grading system to determine its severity. The incidence of Frey's syndrome in 77 patients (25 male and 52 female) under oncological follow-up due to parotid tumors was subjectively evaluated through clinical findings and objectively diagnosed through Minor's test. The positive hyperhydrotic areas were recorded and measured on transparent acetates. Numeric values were assigned according to clinical perception of symptomatology by the patients (0 for no perception and 1 for clinical recognition), extent of the affected area (1 if less than 2 cm; 2 if between 2.1 and 4 cm, and 3 if more than 4 cm), intensity and smell of sweat (3 if it was excessive or of unpleasant odor). Results were expressed as mild (if less than 4 points) or severe grades (if 4 or more points). Frey syndrome was objectively diagnosed in 28 patients (36%), although only 17 (22%) recognized to have clinical manifestations of this condition. There were 22 women (79%) and six men (21%). Of these, seventeen (61%) had been subjected to partial and eleven (39%) to total parotidectomy. Adjuvant radiotherapy had been employed in nine cases (32%). The cutaneous affected area in the whole group ranged from 0.7 to 29.8 cm(2) (mean 8.9 cm(2)), with a mean affected surface of 8.7+/-10.8 cm(2) for women and 9.0+/-8.8 cm(2) for men ( p > 0.05). Twelve cases were classified as mild and sixteen as severe. No significant differences were found between patients treated with partial vs. total parotidectomy or between patients treated with or without adjuvant radiotherapy. The incidence of Frey's syndrome in Mexican patients seems to be similar to those reported in other countries; however, the extent of hyperhydrosis is lower when compared to some European studies. Our proposal for evaluating this condition may be a helpful tool in assessing the incidence and severity among the diverse populations and it may be a useful tool to define more precisely the indications for treatment and to evaluate the available therapeutic methods according to the severity of the condition.

Adolescent↗

Lip cancer experience in Mexico. An 11-year retrospective study.

Lip cancer is the most frequent malignant neoplasm of the oral cavity; however, there is no information available on the incidence of this type of cancer in Mexico. This study provides information about the clinico-pathological features of lip cancer patients admitted at a cancer hospital in Mexico City during an 11-year period and describes the treatment modalities performed and their results. A total of 113 patients were studied. There were 74 men (65.5%) and 39 women (34.5%), ranging in age from 14 to 106 years (mean 70 years). In 53 cases (46.9%) an association was found between the disease and chronic sun exposure. Additionally, positive smoking antecedents were recorded in 58 cases (51.3%). As 15 patients were followed for less than 1 month, they were excluded for further analysis. There were 82 cases (83.7%) of squamous cell carcinoma, 10 (10.2%) basal cell carcinomas, and one case (1%) each of adenocarcinoma NOS, melanoma, adenoid cystic carcinoma, Merkel cell carcinoma, lymphoepithelioma and angiosarcoma. We observed an incidence of malignant neoplasms in the upper lip of 33.7%, which is higher than most of the published series and may be due to the fact that in this series we included all histological types of lip cancers. Fifty percent of the cases were found in stages III and IV. Cervical lymph node metastases were found in 21% of patients with no previous treatment, and they developed in 5.3% after treatment. Our data suggest that tumoral size is directly related to the possibility of developing node metastases, as none of them occurred in patients T1, whereas 10 (62.5%) of the patients in T4 presented them. Seven deaths were documented (7.1%), five of which corresponded to squamous cell carcinoma, one to Merkel cell carcinoma, and one to adenocarcinoma. Deaths were directly related to the disease in six cases, and one patient died due to surgical complications. Distant metastases were found in only two patients, one of which coursed with an adenocarcinoma and the other with a Merkel cell carcinoma. Based on the present results, we suggest that the differences encountered with respect to other series, particularly the higher incidence found in women, the frequent presentation of this type of neoplasms in the upper lip, the wide variety of histopathological diagnoses and the high frequency of cases with cervical lymph node affection, should lead us to search for multi-modal treatment alternatives in this population.

Adolescent↗

Follicular dendritic cell sarcoma of the pharyngeal region: histologic, cytologic, immunohistochemical, and ultrastructural study of three cases.

Follicular dendritic cell sarcoma is a tumor of recent description and characterization; it is often underdiagnosed because it is easily confused with other entities. Three cases of follicular dendritic cell sarcoma are described in the present article. The first occurred in the parapharyngeal space in a 29-year-old woman who developed multiple recurrences over the span of 10 years. The second was located in the left tonsil in a 48-year-old man, and the third case developed in the parapharyngeal space in a 26-year-old man. All cases were positive for CD21 and CD35 and ultrastructurally they displayed a morphologic spectrum. The first case featured spindle cells with interdigitated long cell processes joined by well-developed desmosomes. In the other two cases there were round to ovoid cells with interwoven processes connected by occasional desmosomes. Including these three cases, a total of 20 follicular dendritic cell sarcoma of the pharyngeal region have been reported to date. The clinical behavior of these tumors is similar to other low-grade sarcomas.

Adult↗

Hybrid tumours of the salivary glands. A report of two cases involving the palate and a review of the literature.

Hybrid tumours are very rare salivary gland lesions composed of two or more different tumoural entities in a single neoplasm that arise within a definite topographical region. In most cases adenoid cystic carcinoma has been the predominant component in these lesions. In this study we describe two patients with hybrid tumours located in the palate, one in a 49-year-old woman and one in a 71-year-old man. The first case involved adenoid cystic carcinoma and mucoepidermoid carcinoma, and the patient in the second case exhibited adenoid cystic carcinoma and epithelial-myoepithelial carcinoma. Both patients were treated with surgery and radiotherapy, and there has been no evidence of recurrence after 13 and 36 months of follow-up, respectively. The recognition of the histologic component with the higher grade of malignancy in every case of hybrid tumour of the salivary glands is a necessary step to determine the biological behaviour and, consequently, to determine the proper therapeutic approach.

Aged↗

Odontoameloblastoma. Clinico-pathologic study of three cases and critical review of the literature.

The odontoameloblastoma (OA), is an infrequent neoplasm. To date, there are less than 50 cases reported as OA or ameloblastic odontoma in the English dental literature, but only 14 (including three of our own material), fulfill the histological criteria of the current WHO histological classification of odontogenic tumours. Nine occurred in men and five in women (male to female ratio 1.8:1). Age ranged from 2 to 50 years (mean 20.2 years), and nine cases (64.2%) were diagnosed during the first two decades. Maxilla and mandible were equally involved, and most cases occurred posterior to the canines (71.4%). Follow-up ranged from 6 months to 8 years (mean: 25.5 months). Of the 12 cases with informed follow-up, two recurred once (at 24 and 18 months, respectively), and one case had two documented recurrences, at 6 and 49 months. Although OA tends to occur at an earlier age than conventional ameloblastoma, it has practically the same potential to produce bone expansion, root resorption and recurrence. For these reasons OA should be treated in a similar fashion, with wide surgical excision and close follow-up for at least 5 years.

Adolescent↗

Clear cell odontogenic carcinoma of the mandible.

This article describes a case of clear cell odontogenic carcinoma (CCOC) in a 55-year-old woman who presented such a tumor extending from the midline of the mandible to the right first molar. The tumor was surgically excised and has not recurred or metastasized 6 months after surgery. To date, only 33 well-documented cases have been reported (including the present case) in the English literature. Twenty-eight (84.8%) have developed in the mandible and five (15.2%) in the maxilla. Eighteen (54.5%) occurred anterior to the first molar. The vast majority have been diagnosed in patients older than 40 years (30/33), and the mean age at diagnosis is 57.4 years (range: 17-89), with a male/female ratio: 1/2. Recurrences have been described in 17 cases (51.5%) and metastasis in 10 (30.3%). Based on its morphologic, histochemical and immunophenotypic features, CCOC should be distinguished from other primary and metastatic clear cell tumors of the oral and maxillofacial regions.

Adenocarcinoma, Clear Cell↗

Actinic prurigo cheilitis: clinicopathologic analysis and therapeutic results in 116 cases.

Objective. This study describes the clinicopathologic features and therapeutic results of 116 patients with actinic prurigo cheilitis seen over an 11-year period. Study Design. A retrospective study was carried out with hospital records and a microscopic slide review from a large dermatology department in Mexico City, Mexico. Results. The study consisted of 42 male (36.2%) and 74 female (63.8%) patients, with a male to female ratio of 1:1.7. Age ranged from 9 to 82 years (mean, 27.9 years; standard deviation, 14.2). Thirty-two cases (27.6%) were found in which cheilitis was the only manifestation of this condition. Pruritus, tingling, and pain of the vermilion were recorded in 96 cases (82.7%). Typical histopathologic findings included in most cases the presence of acanthosis, spongiosis, basal cell vacuolation, ulceration with serohematic crust formation, edema of the lamina propria, lymphocytic inflammatory infiltrate with well-defined lymphoid follicles, and variable numbers of eosinophils and melanophages. Improvement of the symptoms was obtained in 112 cases (96.5%) with sun-protective measures and diverse antiinflammatory agents. However, complete resolution of the labial lesions were more frequently achieved with the combination of topical steroids, thalidomide, and sun-protective measures (42.2%) as compared with topical steroid therapy plus sun-protection measures (16.3%; P <.005). Conclusion. Our findings confirm that lip lesions may appear as the only manifestations of this photodermatosis and that it has typical clinical and microscopic features and should therefore be considered a specific form of cheilitis.

Administration, Topical↗

Silicone granuloma of the facial tissues: a report of seven cases.

The liquid form of silicone, called dimethicone (dimethylpolysiloxane), has been used extensively in some countries during the past 4 decades for soft tissue augmentation. Although considered biologically inert, this material has been reported as potentially inducing, after tissue injection, a granulomatous inflammatory response of variable severity. Interestingly, a remarkable paucity of reports exists about the development of complications after injections of liquid silicone into the facial tissues, especially considering its high frequency of use. The purpose of this article is to describe the clinical and microscopic features of 7 cases of silicone-induced granulomas that developed after injection of the facial tissues for cosmetic purposes and to discuss the differential diagnosis and management of this condition.

Adult↗

Paracoccidioidomycosis: report of 2 cases mimicking squamous cell carcinoma.

Paracoccidioidomycosis is an endemic fungal infection in Latin America. This mucocutaneous disease often involves the oral mucosa and may clinically resemble other infectious and neoplastic processes. Paracoccidioidomycosis that clinically suggested squamous cell carcinoma was diagnosed in 2 patients with a history of heavy alcohol and tobacco use. Antifungal therapy with ketoconazole and itraconazole resulted in resolution of the oral lesions. Interestingly, 1 patient had a pulmonary lesion that persisted after antifungal therapy, and biopsy proved this to be a squamous cell carcinoma of the lung.

Antifungal Agents↗

Congenital generalized terminal hypertrichosis with gingival hyperplasia.

Congenital generalized terminal hypertrichosis is a rare disease, especially when associated with gingival hyperplasia. Congenital hypertrichosis can be a clinical feature of several syndromes, so these patients must be studied by a multidisciplinary team that should include a dermatologist, geneticist, psychologist, odontologist, and an endocrinologist. We report a 7-year-old girl with congenital generalized hypertrichosis and gingival hyperplasia, and analyze the clinical approach, differential diagnosis, and treatment.

Child↗

Effect of pilocarpine hydrochloride on salivary production in previously irradiated head and neck cancer patients.

OBJECTIVE: To study the effects of pilocarpine hydrochloride on whole salivary gland production in Mexican patients affected by hyposalivation secondary to radiotherapy of the head and neck region. STUDY DESIGN: With previous written informed consent, 20 patients affected by hyposalivation secondary to head and neck radiation therapy (>40 Gy) were evaluated through the whole saliva test (WST) before, during and after ten weeks of treatment with pilocarpine hydrochloride (5 mg t.i.d.). Hyposalivationrelated symptomatology was assessed before and at every week by means of a questionnaire with an ordinal scale ranging from 0-10. Salivary production values recorded at the end of the study and those obtained before treatment were compared by means of student's t test. A paired Wilcoxon test was used to compare the differences in the oral symptoms, such as oral dryness, soreness, ability for speaking and swallowing before and after treatment. RESULTS: Initial WST had a mean salivary production of 0.8 cm (s.d. 0.7), with a range from 0 to 2.9 cm). After ten weeks of treatment salivary production increased to a mean of 2.24 cm (s.d. 0.7), with a range from 1.2 to 4.0 cm. There was a salivary flow increase of 64.5% (p<0.001). In addition, there were significant improvements in oral dryness, mouth comfort, ability to speak and ability to swallow (p<0.01). Adverse effects were usually minimal and they did not cause withdraw from the study in any case. CONCLUSIONS: Administration of 5-mg pilocarpine hydrochloride tablets three times daily significantly improved salivary production and clinical symptomatology secondary to radiation-induced hyposalivation with minimal side-effects. In addition, this study showed that WST is a fast, technically simple and highly reliable method to study salivary production in prospective studies.

Adult↗

[Dysphagia secondary to lingual thyroid].

BACKGROUND: Lingual thyroid is a rare developmental anomaly originating from aberrant embryogenesis during descent of the gland from its site of origin, the foramen caecum, to its eutopic location. OBJECTIVE: We present the case of a 30-year-old female with a history of dysphagia and pharyngeal foreign body sensation over the past 12 months, associated with hypothyroidism. METHODS: Diagnostic and therapeutic approaches are discussed. RESULTS: Diagnosis of lingual thyroid was made and transoral thyroidectomy was performed as procedure-of-choice. Microscopic analysis revealed normal thyroid tissue with abundant colloid. The patient had an uneventful recovery and was discharged 2 days after surgery. Gamma-gram with Tc99m was scheduled for postoperative follow-up. CONCLUSIONS: Transoral lingual thyroidectomy followed by life-long hormonal therapy is the appropiate approach for patients with severe symptoms due to lingual thyroid hypertrophy associated with hypothyroidism.

Adult↗

Delphian lymph node in glottic carcinoma subjected to supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

INTRODUCTION: Metastases to Delphian lymph node is rarely present in laryngeal malignancy. This report describes its frequency in patients with glottic cancer undergoing supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). MATERIAL AND METHODS: Fourteen patients (13 male and 1 female) with a mean age of 58 years underwent a SCPL with CHEP and functional bilateral neck dissection (levels II-V) searching for the Delphian lymph node. Four patients were in stage I, five in stage II, four in stage III, and one in stage IV. Surgical margins and Delphian lymph nodes were searched for in each partial laryngectomy sample. RESULTS: The mean follow-up was 9 months. The right-side dissection yielded an average of 18 lymph nodes and the left-side dissection yielded an average of 22 lymph nodes, with no metastatic disease on the ultimate examination. Only one patient (7%) revealed a carcinoma-positive Delphian lymph node, and 6 months later a metastatic lymph node was found on the same side as the primary tumor. The patient underwent standard radiation therapy (66 Gy) targeted to larynx and lymph node areas, as well as to the supraclavicular region (20 Gy). DISCUSSION: Bilateral functional dissection is indicated in the presence of Delphian lymph node metastatic spread. Post-operative radiation therapy may occasionally be used as an adjuvant treatment in cases with positive Delphian lymph node in spite of a negative functional dissection in partial laryngectomies due to other possible node spread routes. Bilateral functional dissection should be chosen based on tumor site and size.

Adult↗