• Primary Adenocarcinoma of the Lacrimal Gland

    Paolo Ruscito1, Luca Urbani1, Luigi Sabino1, Massimo Bernardini1, Fabrizo Liberati2

    1 Otolaryngology, Head & Neck Surgery, 2 Pathology, Rieti General Hospital (Italy)

    Primary adenocarcinoma of the lacrimal gland is an extremely rare tumor, arising in the lacrimal fossa, involving the upper eyelid and determining symptoms related to its mass-effect: pain, exophthalmos, dystopia, pseudoptosis. As most reports available in the literature are single-case, management of this disease is quite controversial. Treatment options are surgery and generally post-operative radiation therapy with/without concurrent chemotherapy. They have to face the poor oncological outcome of this disease and try to achieve a radical, possibly eye sparing, excision of the tumor. Due to the limited data available, standardized treatment protocols are not available. A 64-year-old woman visited our hospital complaining of left increasing exophtalmos and orbital pain, following two endorbital excisions of 2.1cm tumor of the lacrimal gland (cT1), resulted as adenocarcinoma G3 at pathological examination. Two months earlier, she had undergone to total conservative parotidectomy and modified radical neck dissection of levels 1-5 for a parotid space extra-capsular nodal metastasis (ECS+). At admission MRI evidenced a 1.6cm extraconical nodular mass of the left lacrimal gland, infiltrating the lateral rectus muscle and displacing the eye, without bone involvement. It resulted as highly suspect for recurrent adenocarcinoma at morphological evaluation, gadolinium-enhanced dynamic studies and diffusion-weighted imaging (DWI). Total body 18F-FDG PET/CT scanning confirmed the high metabolic activity at the primary site (SUV: 8) and did not evidence regional and distant metastases. Therefore the tumor was staged as r cT4, cN0 (previous pN1ECS+), cM0 – St4°A. Treatment planning consisted in salvage surgery for the site of primary tumor and postoperative radiation therapy (intensity modulation radiotherapy, IMRT, 60Gy in 6 week time) comprehensive of the orbit, parotid space, and ipsi-lateral neck. With the aid of harmonic scalpel, in order to reduce bleeding, type IV orbital exenteration was performed, according to Meyer and Zaoli classification, which included eyelids, orbital soft tissues and was extended to the lateral wall of the orbit (zygomatic bone), preserving its orbital frame. Frozen sections of the orbital apex resulted free from disease. Reconstruction was achieved combining temporal mio-fascial flap transposition, through the zygomatic osteotomy, with skin graft apposition to the flap. The Patient was discharged on the 6th post-operative day, as no complication occurred. Histopathological examination of the resected specimen demonstrated primary adenocarcinoma of the lacrimal gland poorly differentiated, 1.3 cm large, with high mitotic activity and tendency to angiolymphatic embolization, infiltrating the orbital soft tissue. It was staged as r pT4a (R0). Six months after the end of post-operative radiation therapy, the patient is alive without evidence of tumor recurrence. The management of orbital adenocarcinoma requires precise planning and has to consider the biological aggressiveness of histology, the necessity to achieve radical excision with adequate free margins, the single-component or composite orbital reconstruction, when required, and eye preservation, when possible. Post-operative radiation therapy seems to reduce the rate of loco-regional recurrences. Whereas the role of chemotherapy remains controversial.

    Lacrimal gland · Adenocarcinoma · Orbital exenteration JAMA Otolaryngology Head & Neck Surgery, Meeting Abstracts from 5th World Congress of IFHNOS

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  • Gozzo della tiroide linguale asportato mediante chirurgia robotica transorale

    Il gozzo multinodulare è raramente presente a livello della tiroide linguale. L’asportazione chirurgica è indicata nei pazienti sintomatici e qualora si sospetti un cancro. L’approccio per via esterna è il più usato, ma è associato con morbilità e sequele. In questo studio, presentiamo per la prima volta, la tecnica di chirurgia robotica transorale (TORS) per la rimozione di un enorme gozzo della tiroide linguale. I dati relativi alla paziente sono stati raccolti in maniera prospettica, considerando: dati demografici, storia clinica, sintomi, comorbidità e farmaci assunti. Il “Da Vinci Surgical System” è stato utilizzato per l’approccio transorale all’orofaringe. La tecnica è stata eseguita in una donna di 31 anni con segni e sintomi di gozzo multinodulare presenti dall’infanzia. La procedura è durata 115 minuti suddivisi nei seguenti intervalli: tracheotomia, 25 minuti; installazione del robot, 20 minuti; tempo chirurgico alla console, 70 minuti. La TORS è eseguibile in caso di localizzazione di gozzo multinodulre a livello della tiroide linguale. La procedura sembra essere sicura con rapida ripresa deglutitoria e fonatoria.

    Gozzo della tiroide linguale · Chirurgia robotica transorale · Ectopie tioidee Acta Otorhinolaryngol Ital 2013;33:343-346

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  • La chirurgia robotica transorale (TORS) nel trattamento dei tumori della base lingua

  • I fattori prognostici per le complicanze della ferita chirurgica dopo svuotamento linfatico del collo

  • Il trattamento chirurgico dei tumori dello spazio parafaringeo: risultati di 10 anni di follow-up

  • Oral Cavity and Base of the Tongue Tumors. Correlation between Clinical, MRI and Pathological Staging of Primary Tumor

  • Il trattamento delle metastasi laterocervicali in stadio avanzato

  • Adattamento culturale e validazione di tre scale per la valutazione del dolore e della disfunzione della spalla dopo svuotamento linfonodale laterocervicale: Università della California - Los Angeles (UCLA) Scala per la Spalla, Indice di Dolore e Disabilità della Spalla (SPADI) e Test Semplice della Spalla (SST)

  • Metastatizzazione linfonodale e fattori prognostici nel carcinoma differenziato della tiroide

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Libri e CD

Carcinomi della laringe e dell'ipofaringe: trattamenti integrati


Atlas of Head & Neck Surgery

Chapter 44 - Partial Pharyngectomy

Atlas of Head & Neck Surgery

Chapter 45 - Horizontal Supraglottic Laryngectomy

Atlas of Head & Neck Surgery

Chapter 35 - Horizontal Supraglottic Laryngectomy

Fondamenti di Oncologia Clinica

Tumori della testa e del collo