Human HOX genes encode transcription factors that act as master regulators of embryonic development. They are important in several processes such as cellular morphogenesis and differentiation. The HOXB5 gene in particular has been reported in some types of neoplasm, but not in oral cancer. OBJECTIVE: The present study investigated the expression of HOXB5 in oral squamous cell carcinoma (SCC) and in non-tumoral adjacent tissues, focusing on verifying its possible role as a broad tumor-associated gene and its association with histopathological and clinical (TNM) characteristics. MATERIAL AND METHODS: RT-PCR was performed to amplify HOXB5 mRNA in 15 OSCCs and adjacent non-tumoral epithelium. A possible association with TNM and histopathologic data was verifed by the chi-square and post-hoc t-test. RESULTS: HOXB5 was amplifed in 60% non-tumoral epithelium and in 93.3% carcinomas. No statistically signifcant differences were found regarding the HOXB5 mRNA expression and TNM or histological grade. CONCLUSION: HOXB5 is expressed in OSCCs and its role in cancer progression should be further investigated.

PURPOSE: Despite the advances in microvascular free tissue transfer for intraoral reconstruction, this surgery is not recommended for all patients. In specific cases, the pedicled temporoparietal galeal flap may be an option for reconstructive procedures in the head and neck regions. The objective of this paper is to present the anatomical aspects of a galeal flap based on the superficial temporal vessels and to test its potential for reconstructing diverse sites of the oral cavity and pharynx. METHODS: We performed 40 dissections on 34 fresh adult cadavers. The flap vascular anatomy was studied by injecting latex into the superficial temporal vessels. A standardized square-shape flap measuring 10 x 10 cm², pedicled on the superficial temporal vessels, was raised. Oral cavity and oropharynx reconstruction simulations were performed after flap transposition into the mouth by passing it under the zygomatic arch. Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve. RESULTS: After latex injection, a rich vascular network over the temporoparietal galea was observed directly from the superficial temporal artery, and a well-vascularized flap based on this vessel was raised. In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa. CONCLUSIONS: A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

O presente estudo realizou teste de campo para uma versão em Português do questionário de qualidade de vida da Universidade de Washington (UW-QOL, 3ª versão), com o intuito de avaliar sua capacidade em descrever padrões diferenciais de qualidade de vida de pacientes com câncer de boca no contexto brasileiro. Foram entrevistados 100 pacientes com carcinoma epidermóide oral no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os resultados foram comparados por características sócio-demográficas e clínicas dos pacientes. Após um ano, 20 pacientes haviam falecido e 24 não foram localizados. A re-entrevista dos demais permitiu o acompanhamento longitudinal de modificações na auto-avaliação de qualidade de vida. Pacientes com tumores maiores e neoplasia na porção posterior da boca apresentaram indicadores de pior qualidade de vida (p < 0.05). Mastigação foi o item com pior avaliação (35,0/100,0) e maior proporção de queixas, tanto na avaliação inicial como no seguimento longitudinal. O questionário permitiu identificar relevantes contrastes (na comparação de características clínicas) e similaridades (na comparação de características sócio-demográficas) entre os grupos de respondentes. Seu uso regular no hospital pode contribuir para reduzir o impacto das aplicações terapêuticas e aprimorar a gestão dos tratamentos.

This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, 3rd version), aiming at appraising its ability to identify different patterns of health-related quality of life of patients with oral cancer in Brazil. Patients (N = 100) were interviewed as they were undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital ("Hospital das Clínicas", School of Medicine, University of São Paulo). The results were compared based on categories of socio-demographic and clinical characteristics of the patients. At a one-year follow-up, 20 patients had died, and 24 were considered dropouts. The remaining patients accounted for the longitudinal assessment of modifications in the self report of quality of life. Patients with larger tumours and neoplasms in the posterior part of the mouth presented significantly (p < 0.05) poorer indications of quality of life. Chewing was the poorest rated domain (35.0/100.0), and presented the highest proportion of complaints both at the baseline and at the follow-up assessments. The questionnaire allowed the identification of important contrasts (while comparing clinical characteristics) and similarities (while comparing socio-demographic status) among subsets of respondents, and it can contribute to reduce the impact of treatments and improve subsequent patient management.

CONTEXTO E OBJETIVO: A abordagem adequada do carcinoma de paratireóide parece relacionada à capacidade de identificação pelo cirurgião na primeira operação. O objetivo do estudo foi avaliar o papel da suspeita clínica pré-operatória na abordagem do carcinoma de paratireóide. TIPO DE ESTUDO E LOCAL: Análise retrospectiva realizada no Departamento de Cirurgia de Cabeça e Pescoço, da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. MÉTODOS: De 1995 a 2000, 143 pacientes foram operados por hiperparatireoidismo. Esses casos foram revistos para verificar se a suspeita clínica pré e intra-operatória de carcinoma de paratireóide foi útil para a realização de operação mais extensa e quais fatores melhor se relacionaram com a suspeita de carcinoma. RESULTADOS: Entre 66 casos de hiperparatireoidismo primário, houve quatro casos de carcinoma de paratireóide (6,1%), e um caso foi encontrado em hiperparatireoidismo secundário (1,3%). Nódulos palpáveis foram observados em cinco pacientes com hiperparatireoidismo primário, quatro deles com carcinoma de paratireóide. Os níveis pré-operatórios da calcemia nos casos de carcinoma de paratireóide de hiperparatireoidismo primário variaram entre 12,0 mg/dl e 18,2 mg/dl. Em dois pacientes, o tumor tinha invasão macroscópica de estruturas adjacentes. Com exceção de um caso, com doença extensa, houve ressecção completa em monobloco dos tumores. No hiperparatireoidismo secundário, o carcinoma de paratireóide foi identificado numa quinta glândula mediastinal. Houve um caso de adenoma atípico. CONCLUSÕES: O nível de calcemia muito elevado, o tumor palpável e a aderência a estruturas próximas são comuns no carcinoma de paratireóide. Esses sinais clínicos podem ser úteis na tomada de decisão nas operações sobre a glândula paratireóide.

CONTEXT AND OBJECTIVE: Adequate management of parathyroid carcinoma apparently relates to the surgeon’s ability to identify it at the first operation. The objective of this paper was to evaluate the role of clinical suspicion in the management of parathyroid carcinoma. DESIGN AND SETTING: Retrospective analysis of parathyroid carcinoma patients treated in Department of Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo. METHODS: Cross-sectional study of 143 patients who underwent surgery from 1995 to 2000, due to hyperparathyroidism. These cases were reviewed to ascertain whether preoperative and intraoperative suspicion of parathyroid carcinoma were helpful during the operation, and which factors demonstrated the suspicion of cancer best. RESULTS: Among 66 patients with primary hyperparathyroidism there were four cases of parathyroid carcinoma (6.1%), and one case was found in secondary hyperparathyroidism (1.3%). Palpable nodules were found in five patients with primary hyperparathyroidism, four of them with parathyroid carcinoma. Preoperative levels of calcium in primary hyperparathyroidism with cancer patients varied from 12.0 mg/dl to 18.2 mg/dl. Two patients had gross macroscopic spread of the tumor to adjacent structures. Except for one patient, with extensive disease, tumors were resected en bloc. In secondary hyperparathyroidism, parathyroid carcinoma was found in a fifth mediastinal gland. One atypical adenoma was observed. CONCLUSIONS: High levels of calcium, palpable tumors and adherence to close structures are more common in parathyroid carcinoma. These clinical signs may be helpful for decision-making during parathyroid surgery.

OBJETIVO: Caracterizar epidemiológica e clinicamente a população atendida por câncer de boca em hospital-escola de atenção terciária e quaternária e verificar variações em relação a outras casuísticas e períodos. MÉTODO: Procedeu-se à revisão dos prontuários dos operados por câncer oral de 1994 a 2002. As características clínicas e epidemiológicas foram colocadas em planilhas e analisadas. RESULTADOS: Foram identificados 374 portadores de câncer da boca que foram submetidos a 406 operações. A idade dos doentes variou de 14 a 94 anos (média = 57,4 anos). Duzentos e cinqüenta e cinco eram do gênero masculino (68,2%). Duzentos e noventa e cinco entre 366 doentes eram caucasianos (80,6%). A maioria era portadora de tumores da língua e/ou do soalho da boca (194 entre 349 doentes; 55,6%), e 71 (20,3%) tinham tumores dos lábios. O carcinoma epidermóide foi encontrado em 90,3% e carcinomas glandulares em 4%. Os tumores T4 estavam presentes em 39,6% dos doentes; 15,2% tinham lesões Tis ou T1. Quase 62% dos pacientes não tinham metástases cervicais. A incidência relativa em jovens (com até 40 anos de idade) atingiu 8,6%. CONCLUSÃO: Apesar dos achados freqüentemente referidos na literatura terem se confirmado (como o predomínio de lesões avançadas localmente), a maioria dos doentes não apresentava metástases cervicais. Acima do observado em outras casuísticas, os 31,8% de mulheres na presente casuística indica a preocupante e crescente incidência no gênero feminino.

PURPOSE: Description of clinical and epidemiological characteristics of patients who underwent surgery for oral cancer in a Medical School Teaching Hospital, and determination of differences with respect to other institutions and/or periods of time. METHOD: The charts of patients undergoing surgery for oral cancer from 1994 to 2002 were reviewed. Data were collected in a spreadsheet in order to analyze clinical and epidemiological features.. RESULTS: A total of 374 patients having undergone 406 operations was identified. Their ages varied from 14 to 94 years (mean = 57.4 years), with 255 men (68.2%), and 295 out 366 Caucasian (80.6%). A majority had tumors of the tongue and/or floor of mouth (55.6%), while 20.3% had lip cancer. Squamous cell carcinoma was found in 90.3%, and glandular carcinoma in 4%. T4 tumors in 39.6%, Tis or T1 lesions in 15.2% of all patients. Nearly 62% had no regional metastases, and the relative incidence in young patients (40 years or younger) reached 8.6%. CONCLUSION: In spite of the predominance of locally advanced tumors, a majority of patients had no neck metastases. The 31.8% incidence in females indicates an increasing incidence of oral cavity cancer among women when compared to previous periods at the same institution.