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Title: Correlação Clínico-Histopatológica entre Dor e Invasão Perineural nos Carcinomas da Cabeça e do Pescoço
Keywords: Dor no cancer;  Invasão perineural;  Dor em cabeca e pescoço;  Pain cancer;  Perineural invasion;  Head and Neck pain;  Dor;  Carcinomas;  Invasividade neoplásica
Issue Date: 18-Feb-2004
Publisher: Universidade Federal Fluminense
Abstract: Keeping in mind a better quality of life and quick recovery for the patient, the understanding of the intervening factors related to the presence of pain caused by malignant tumors in the head and neck area makes possible to establish diagnosis, therapeutic and prognosis methods in these cases. One important algogenic factor is the invasion of the nervous tissues by the carcinomas, which can happen early in a microscopic level or lately by dissemination through nerve trunks. The aim of this work is to study the presence of pain and microscopic perineural invasion in patients bearing head and neck carcinomas, basically correlating them to each other and to other clinical and atomopathological variables i.e. sex, ethnicity, age, pain intensity, McGill index, histological type, tumor location, staging, bone infiltration, tumor size and lymph node involvement. In this work, we studied a random sample of 50 consecutive patients with confirmed histopathologic diagnosis (through biopsy) of head and neck carcinoma, whose treatment involved the attempt of complete surgical tumor resection. Before the surgical procedure, we interviewed each patient using a standard clinical questionnaire especially designed for the study. Additional information was obtained through patient s medical records in the institution. After surgical resection, the material was sent for anatomopathological routine study and then checked for the presence of perineural invasion. The revision process involved analysis via both haematoxylin-eosin stain and immunohistochemical technique using S-100 anti-protein antibody. Thirty-six (72%)from 50 analysed patients were male and 14 (28%) female. The average age was 54.7 years old. White ethnicity was prevalent within 70% of the cases. When asked about the presence of pain within the previous 30 days, 27 patients (54%) answered positively. Perineural invasion was present in 20 individuals (40%). The anatomopathological investigation of tumoral staging showed a greater frequency of stage 1 carcinomas and of the moderately differentiated squamous cell type. With reference to the location of the tumors, there was a prevalence of mouth and larynx involvement. We did not find significant difference between patients with and without pain regarding cases showing perineural invasion. Likewise, there was no statistical correlation between pain presence and gender, ethnicity, age, histological type, bone involvement, tumoral staging or lymph node invasion. There was a significant difference between larynx and skin locations, and T1 and T2 sizes, regarding the proportion of patients referring pain. No statistical correlation was found between perineural invasion and gender, ethnicity, age, VAS, McGill index, histological type, bone involvement, staging, size or affected lymph nodes. The correlation between perineural invasion and tumor location showed significant difference between larynx and skin regarding the proportion of cases showing perineural invasion (p = 0.033). The correlation between McGill index and VAS semi quantitative variable was also studied, and the Spearman correlation coefficient showed a relationship between VAS and McGill index (r = 0.934; p < 0.001). Thus, one cannot consider microscopic neural invasion as an isolated factor in the production of pain in head and neck. New researches are necessary to bring to light the mechanisms that trigger pain, or the individual differences in pain threshold. This work also revealed a significant statistical difference regarding the presence of pain and perineural invasion when comparing larynx and skin carcinomas.
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