Javier López-Gómez

Oral squamous cell carcinoma (OSCC) is one of the most common malignancies affecting the head and neck and account for over 90% of all oral cancers (1)

Introduction: Intestinal stomas are created for distinct clinical conditions. They may involve the small bowel (ileostomy) or the large bowel (colostomy), depending on the objective or site of the stoma. Intestinal stomas may be temporary or permanent; they cause loss control of intestinal transit due to the absence of a sphincter that regulates its exit, provoking a continuous passage of fecal matter through the stoma. Within the environment of the ostomized patients, there are several important complications involving their quality of life. Case presentation: The Intestinal Valve Type Artificial Sphincter (VITEA) device is placed in a patient diagnosed with cervical cancer, who has a vaginal-rectum fistula that requires a definitive colostomy. Discussion: Intestinal stomas have been validated for over a century. We present the case with a similar complication rate to those described after performing a stoma with conventional open technique in terms of quality of life and cost-benefit ratio. The proportion of complications and the quality of life found in the ostomized patient with the VITEA* device is acceptable, and also eliminates the colostomy bags, providing the function of an artificial sphincter by everting the mucosa on the same device. No complications were found during the follow-up. Conclusions: The results from this proposal will allow to evaluate the safety and efficacy profile associated with a stomal bags. Highlights:

Introduction: Tracheostomy is an emergency procedure; however, 85% of cases are due to malignant neoplasms. For different types of neoplasia, till date there are no algorithms in literatures for the management of airway obstruction. Objective of the study: To Generate an algorithm for the management of airway obstruction in head and neck cancer patients. Material and methods: An exhaustive bibliographical search was carried out in PubMed database with the MeSH terms “malignant airway obstruction/surgery”, “airway obstruction/etiology”, “airway management/ standards”. Patients with airway obstruction and its management that included cancer were studied, the most outstanding authors in the subject were identified through the Science Citation Index and the exchange of information was carried out with specialists in the subject. A total of 344 articles were found to be reviewed, of which 11 articles addressing obstruction in the cancer patient were selected for review. Results: A management algorithm is created combining the oncological characteristics of the patient (type of tumor, clinical status, functional status, treatment) anesthetic management as well as surgical treatment. Patients with airway obstruction that can be intubated are preferred cytoreduction with CO2 and biopsy in case of cancer of the larynx, oropharynx or oral cavity; if the patient cannot be intubated, supraglottic devices or facial mask can be used. In case of failure, cricothyrotomy is performed. Once the airway is controlled, the tracheostomy is performed; complementary treatment specifications are made in the different types of tumors (larynx, thyroid, oral cavity and oropharynx). Discussion: Creating a management algorithm is of vital importance since everything is not resolved with “tracheostomy”. For decision making, there are no data available in other literature that groups all the oncological head and neck disorders. Therefore, a management algorithm is proposed based on the bibliographic review and the exchange of information with specialists in head and neck cancer. Conclusion: We propose a management algorithm based on the characteristics of the patients and tumor with the current anesthetic management.

Introduction: Chondrosarcoma constitutes 0.2% of all malignant tumors of the larynx. Many surgeons treat it with total laryngectomy due to the limited experience with this neoplasm because its rarity, and although several conservative approaches have been proposed, the data of these techniques are limited and based on retrospective series. Presentation of case: A 52-year-old male with a transglottic submucosal tumor and glottic stenosis in fiberoptic examination showed by tomography a laryngeal tumor that infiltrates vocal cords, glottis, cricoid and thyroid cartilage of 3 × 2.7 × 4 cm. Patient was submitted to total laryngectomy with selective bilateral neck dissection because obstructive tumor. Pathology reported a cricoid cartilage tumor consistent with grade 2 chondrosarcoma. Discussion: Biopsy by laryngoscopy is considered the standard procedure for the diagnosis of laryngeal tumors, however the need for general anesthesia and the difficulty in intubation in some patients with large tumors make difficult to obtain an adequate biopsy in some cases with submucosal tumor. Conservative surgeries should be individualized based on the size and location of the tumor as well as on the patient's general conditions. Radical treatment is recommended for high-grade and large tumors in which conservative surgery would destabilize the cricoid ring. Conclusion: There is no diagnostic and treatment approach established for laryngeal chondrosarcoma, we believe that percutaneous biopsy would be the diagnostic test of choice because it is less invasive and has a high sensitivity and specificity; it could also identify patients who are candidates for conservative surgeries. Highlights:

INTRODUCTION: Intimal sarcoma is an extremely rare group of undifferentiated pleomorphic sarcoma arising from the intimal layer of vessels accounting for only 1% of all sarcomas, intimal sarcoma of large veins are even less common. CASES PRESENTATION: We present two cases of intima sarcoma, one originated form the basilar vein and the other from the cephalic vein, the first one was treated with surgery and postoperative chemotherapy followed by Radiotherapy (RT), the second case was treated with isolated limb perfusion followed by marginal resection and RT. Both patients progressed to the lungs in a short time, the first case was treated with metastasectomy of the lung and is without evidence of disease 7 months after surgery; the second case treated with isolated limb perfusion has stable disease. DISCUSSION: Intimal sarcoma are very aggressive tumors, with a high metastatic potential, the two patients progressed to lung in a short time (2 months) after local treatment. Both cases exhibit good response to chemotherapy and metastasectomy with a disease – free period of 7 months. CONCLUSION: We propose that given the aggressive behavior of these tumors, they should be treated with chemoradiotherapy postoperative, either by systemic chemotherapy or isolated limb perfusion for the limp sparing surgery in this histology. Highlights:

Thyroglosal duct cyst is a common anomaly with an incidence of 7% in adults, the rate of carcinoma in TGDC is 0.7-1.6%, and are extremely rare those originated in the hyoid bone. A 60 years old male patient, had a hard mass in the anterior neck. CT revealed a hyoid tumor. Hyoid bone resection was performed, the pathological report show a conventional papillary carcinoma in bone tissue. We rule out primary tumor in thyroid gland. Five years later, he developed a neck node recurrence. Total thyroidectomy and a selective left neck dissection (II-IV levels) was performed. He received radioiodine adjuvant treatment. Hyoid cancer originates of a persistent thyroglosal duct remnants inside hyoid bone. We propose to add a new subdivision to pathology derived from thyroglosal duct remnants). The diagnostic approach with ultrasound and CT are necessary. A primary in te hyoid gland mustang be discorded, and then the entire hyoid bone must be removed. Treatment of the thyroid gland and neck should be considered when there are significant risk factors of recurrence, similarly to thyroid cancer based on the risk assessment.

INTRODUCTION: Malignant pheochromocytoma represents 10% of all patients with pheochromocytoma. Of these cases, only 5–9% presents without elevation of metanephrines and catecholamines. PRESENTATION OF CASE: A 43-year-old female patient presented with an abdominal tumor. An exploratory laparotomy was performed and the final report was a pheochromocytoma. After ten years, multiple liver lesions were detected and surgical treatment was performed. Pathological evaluation revealed a malignant pheochromocytoma with negative margins after 5 years of follow-up without evidence of disease. DISCUSSION: The recurrence rate of malignant pheochromocytoma is 15–20% at ten years and a 5-year survival rate that ranges from 50% to 80%. The presence of synchronous metastases is rare (10–27%), but have been reported until 20 years later with the most common metastatic sites being the local lymph nodes, bone (50%), liver (50%) and lung (30%). The prognostic factor such as size >6 cm, age over 45 years, synchronous metastasis and no tumor excision are related with poor prognosis. CONCLUSION: Surgical treatment offers the best survival rate and the only chance of cure so far and the goal is an R0 resection as in our case. So it should be the treatment of choice. Highlights:

Management of a borderline ovarian tumor in a pregnant woman in a rural hospital: a case report