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Tumores do espaço parafaríngeo: experiência de 10 anos do IPO-LFG
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Advisor(s)
Abstract(s)
Introdução: As neoplasias do espaço parafaríngeo são
raras, representando apenas 0,5% dos tumores da cabeça e
pescoço. A maioria são benignas, mas uma ampla variedade
de patologias benignas e malignas podem ser encontradas
neste espaço, o que cria desafios complexos de diagnóstico
e tratamento.
Objetivo: Descrever e analisar uma série de casos de
neoplasias primárias do espaço parafaríngeo tratadas no
Instituto Português de Oncologia de Lisboa Francisco Gentil
(IPOLFG).
Material e métodos: Estudo retrospetivo, com recolha
e análise dos dados dos processos clínicos de tumores
primários do espaço parafaríngeo, que foram diagnosticados
ou referenciados ao IPOLFG entre 1 de Janeiro de 2003 e 31
de Dezembro de 2013.
Resultados: Foram incluídos 38 doentes. A idade mediana
foi de 52 anos (Âmbito Interquartil: 40-63 anos). Dez (26,3%)
doentes eram assintomáticos. O sintoma mais comum à
apresentação foi a sensação de corpo estranho orofaríngeo
(23,7%) e o achado mais frequente foi um abaulamento
orofaríngeo (78,4%). Todos os doentes fizeram exames de
imagem pré-operatórios: 94,7% tomografia computorizada e 68,4% ressonância magnética. A citologia aspirativa foi
realizada em 39,5%. 31 tumores eram benignos (81,6%),
sendo os mais frequentes os adenomas pleomórficos
(58,1%). 7 eram malignos (18,4%), com os carcinomas exadenomas
pleomórficos (28,6%) e os linfomas (28,6%) sendo
os mais comuns. 36 doentes (94,7%) foram submetidos a
tratamento cirúrgico primário; os outros 2 doentes (5,3%)
receberam tratamento não cirúrgico, com quimioterapia e
quimioradioterapia, respectivamente. A abordagem cervical
foi a mais utilizada (80%). A mandibulotomia foi necessária em
apenas 5,7%. A complicação mais frequente foi a neuropatia
de pares cranianos de novo, identificada em 22,2%. Destes,
75% foram sequela da resseção de tumores neurogénicos.
Todas as neuropatias que resultaram da resseção de tumores
não neurogénicos foram transitórias. O follow-up mediano foi
de 6,5 anos. A taxa de recorrência foi de 13,5%.
Conclusões: Os tumores do espaço parafaríngeo requerem um
elevado índice de suspeição para serem diagnosticados num
estadio precoce. A resseção cirúrgica completa é o principal
tratamento. A abordagem cirúrgica deve ser selecionada caso
a caso, mas a cervical fornece um excelente acesso à maioria
dos tumores deste espaço
Introduction: Parapharyngeal space neoplasms are rare, accounting for only 0.5% of head and neck tumors. The majority of PPS tumors are benign, but a wide spectrum of pathologies, both benign and malignant, has been encountered in this region. This range of histopathologies in combination with the complex anatomy of the parapharyngeal space creates complex diagnostic and management challenges. Objective: To describe and analyze a case series of primary parapharyngeal space neoplasms at Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG). Methods: Retrospective review of medical records of patients with parapharyngeal space neoplasms, diagnosed or referred to IPOLFG between 1st of January of 2003 and 31st of December of 2013. Results: 38 patients were included. The median age was 52 years (Interquartile range 40-63). 10 patients (26.3%) were asymptomatic. The most common symptom was an oropharyngeal lump sensation (23.7%). All patients had preoperative imaging: 94.7% computed tomography and 68.4% magnetic resonance image. 39.5% underwent fineneedle aspiration biopsy. 31 tumors were benign (81.6%), with pleomorphic adenomas comprising the majority (58.1%). 7 were malignant (18.4%), with carcinoma ex pleomorphic adenoma (28.6%) and lymphoma (28.6%) being the most common. 36 patients (94.7%) underwent primary surgical management; the other 2 patients (5,3%) were treated with chemotherapy and chemoradiotherapy, respectively. The cervical approach was the most common (80%). A mandibulotomy was required in just 5.7% of primary cases. The most frequent complication was cranial neuropathy, identified in 22,2%. Of these, 75% were sequelae from resection of neurogenic tumors. Median follow-up was 6.5 years. Conclusion: PPS tumors require a high index of suspicion to diagnose them at an early stage. Complete surgical resection is the mainstay of treatment. The optimum surgical approach needs to be selected on an individual basis, but the cervical approach is safe and effective for most PPS neoplasms.
Introduction: Parapharyngeal space neoplasms are rare, accounting for only 0.5% of head and neck tumors. The majority of PPS tumors are benign, but a wide spectrum of pathologies, both benign and malignant, has been encountered in this region. This range of histopathologies in combination with the complex anatomy of the parapharyngeal space creates complex diagnostic and management challenges. Objective: To describe and analyze a case series of primary parapharyngeal space neoplasms at Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG). Methods: Retrospective review of medical records of patients with parapharyngeal space neoplasms, diagnosed or referred to IPOLFG between 1st of January of 2003 and 31st of December of 2013. Results: 38 patients were included. The median age was 52 years (Interquartile range 40-63). 10 patients (26.3%) were asymptomatic. The most common symptom was an oropharyngeal lump sensation (23.7%). All patients had preoperative imaging: 94.7% computed tomography and 68.4% magnetic resonance image. 39.5% underwent fineneedle aspiration biopsy. 31 tumors were benign (81.6%), with pleomorphic adenomas comprising the majority (58.1%). 7 were malignant (18.4%), with carcinoma ex pleomorphic adenoma (28.6%) and lymphoma (28.6%) being the most common. 36 patients (94.7%) underwent primary surgical management; the other 2 patients (5,3%) were treated with chemotherapy and chemoradiotherapy, respectively. The cervical approach was the most common (80%). A mandibulotomy was required in just 5.7% of primary cases. The most frequent complication was cranial neuropathy, identified in 22,2%. Of these, 75% were sequelae from resection of neurogenic tumors. Median follow-up was 6.5 years. Conclusion: PPS tumors require a high index of suspicion to diagnose them at an early stage. Complete surgical resection is the mainstay of treatment. The optimum surgical approach needs to be selected on an individual basis, but the cervical approach is safe and effective for most PPS neoplasms.
Description
Keywords
Neoplasias da faringe Neoplasias da cabeça e pescoço Procedimentos cirúrgicos otorrinolaringológicos
Citation
Rev Port Otorrinol Cirur Cerv Fac. 2016,54(1)23-31
Publisher
Sociedade Portuguesa de Otorrinolaringologia e Cirurgia Cérvico-Facial