Cervical metastasis from testicular teratoma

The presence of neck metastasis in patients with testicular germ cell neoplasms in a rare but well known phenomenon. The incidence of neck metastasis in testicular carcinoma has been reported to be present in a 5% of cases. When cervical metastasis occurs, surgical resection of the residual disease following chemotherapy and using a specific technique of modified neck dissection results in a surprisingly improvement of the prognosis.     

Modified neck dissection for metastatic testicular carcinoma

Carcinoma of the testicle is a unique clinicopathologic entity in that an optimistic attitude toward cure can be entertained even in the presence of distant metastasis. Chemotherapy, followed by an aggressive surgical resection of residual disease, can result in eradication of this neoplasm. This tumor is capable of being monitored by the use of serum markers, namely, human chorionic gonadotropin and alpha-fetoprotein. After induction chemotherapy, the transition of elevated serum tumor markers to normal levels suggests that malignant disease has been eliminated or converted to teratoma. Elevated markers indicate persistent or recurrent carcinoma and mandate further chemotherapy. If normalization of tumor markers occurs, any residual mass in the abdomen, chest, or neck should be surgically resected. The otolaryngologist plays a role in the diagnosis and the resection of residual neck disease. Metastatic testicular carcinoma can present as a supraclavicular neck mass and must be considered in the differential diagnosis of a mass in this area. Large residual neck lesions are best removed through the exposure afforded by modified neck dissection.     

Metastatic seminoma with cervical lymphadenopathy as the initial manifestation

Advanced testicular germ cell tumors commonly involve cervical lymph nodes. In most circumstances, the diagnosis of germ cell tumor is established before the neck disease is noted. In rare cases, these tumors have been found along with cervical lymphadenopathy in patients with a previously undiagnosed primary tumor. In this article, we report the unusual case of a 71-year-old man whose metastatic seminoma initially manifested as an asymptomatic neck mass. This finding reinforces the need to include metastatic disease in the differential diagnosis of neck masses. Our discussion of this case focuses on the appropriate management of cervical metastases of germ cell tumors.     

Oncocytic carcinoma of the nasal cavity with widespread lymph node metastases

The first case of oncocytic carcinoma which arose from the inferior turbinate of the nasal cavity with orbital invasion through the nasolacrimal canal and widespread lymph node metastases in the neck and face is reported here. The tumor metastasized rapidly, spread widely to the whole neck and face, and produced tumor emboli in the lymphatics and extranodal extension by rupture of the lymph node capsule in the absence of clinically palpable regional lymph node enlargement. We think the oncocytic carcinoma of the nasal cavity may be a high-grade malignancy tumor.     

Glomus intravagale

Glomus intravagale (paraganglioma of the nodose ganglion and/or vagus nerve) is an unusual tumor. There are approximately 45 cases reported in the literature; the authors report four more cases. This tumor may be associated with other paragangliomas of the head and neck, such as carotid body tumors, and may metastasize to regional lymph nodes, although the histology always appears benign.     

Malignant fibrous histiocytoma of the bucca: a case report

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma, but is relatively uncommon in head and neck area. Histologically, it is difficult to distinguish this tumor from other sarcomas and carcinomas. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumor in the head and neck is low in comparison with MFH of the extremities and trunk. In the case reported here, the patient was a 61-year-old man who presented with swelling and pain of the left bucca. A CT scan demonstrated a 2.5 cm x 5.0 cm inhomogeneous lesion. In MRI, the tumor displayed an inhomogeneous isointense signal on T1-weighted images and a high-intensity signal on T2-weighted images. Fine-needle aspiration (FNA) was performed twice but we were unable to reach a definitive diagnosis histologically. MFH was subsequently diagnosed by open biopsy, and external radiotherapy with 38 Gy of radiation was performed. However, the tumor enlarged after this therapy, and therefore CyberKnife therapy was performed twice, after which the tumor gradually reduced in size. The patient is alive after a follow-up period of 22 months, and therefore we suggest that CyberKnife treatment may be useful for head and neck MFH.     

Three cases of cell granular tumor of the larynx

Cell Granular Tumor (CGT) are unusual tumors that can affect any site of the body, with most cases affecting the head and neck region. CGT of the larynx is an uncommon laryngeal tumor accounting for approximately 6-10% of the reported cases. In the larynx pseudoepitheliomatous hyperplasia may predispose to confuse the CGT with frothy (squamous) cell carcinoma. The origin of this tumor is a matter of debate but most authors believe it to be neural in origin.     

Schwannomas of the head and neck in children

Schwannomas are relatively rare tumors that arise from Schwann cells of the sheaths of peripheral nerves. They may be found in any portion of the body. In reported series of schwannomas, the percentage of tumors in the head and neck varies from 16% to 45%. Usually demonstrating slow growth, they often have a history of long duration, and are most often diagnosed in adults. Approximately 10% of schwannomas are diagnosed in patients under 21 years of age. In this paper two children with large schwannomas of the head and neck are reported. In both, the symptoms were of relatively short duration, but physical findings suggested that the tumors had been present much longer. One patient was a 10-year-old female with a schwannoma filling the anterior and posterior triangles of the left side of her neck and extending superiorly to the base of the skull. The tumor intimately involved the vagus, spinal accessory, and hypoglossal nerves. The other patient was a 12-year-old female with a nasal tumor filling the right naris and nasopharynx. Our management of these patients is discussed.     

Coexistence of a Carotid Body Tumor and Thyroglossal Duct Carcinoma With Cervical Lymph Node Metastasis

Thyroglossal duct carcinoma is uncommon, occurring in approximately 1% of all thyroglossal duct remnants. This rare neoplasm is characterized by relatively nonaggressive behavior with infrequent lymph nodal spread. Another rare neoplasm of the head and neck region is a carotid body tumor. A 78-year-old woman with a 3-year history of midline and bilateral neck masses was referred to us. Fine needle aspiration biopsies and a computed tomography scan suggested the diagnosis of thyroglossal duct carcinoma with cervical lymph node metastasis. Interestingly, the left-side neck mass was found to be splaying the carotid bifurcation, on computed tomography imaging. Carotid arteriography demonstrated a highly vascular mass in the bifurcation of the carotid artery that was compressing the internal and external carotid arteries. To our knowledge, this is the first reported instance of a thyroglossal duct carcinoma with neck metastasis accompanied by a carotid body tumor. In addition, the carotid body tumor in this case mimicked neck metastasis from the thyroglossal duct carcinoma.     

An unusual laryngeal lesion in children: granular cell tumor

Granular cell tumor, a relative rare neoplasm, is of particular interest of the otolaryngologist as some 50% of cases appear in the head and neck region. The youngest reported case of a laryngeal granular cell tumor is presented. Involvement of the larynx is uncommon, but when it occurs it may create diagnostic and therapeutic dilemmas.     

Chondrosarcoma of the hyoid bone: imaging, surgical, and histopathologic correlation

Objectives/Hypothesis: Rare diseases must be diagnosed with great caution, so we present this case to familiarize clinicians with the presentation and treatment of chondrosarcoma of the hyoid bone, a rare disease. Study Design: Case report and review of the literature. Methods: We report one case of chondrosarcoma of the hyoid bone which presented with upper midline neck mass. In addition, we review the literature published in English regarding chondrosarcoma of the hyoid bone. Results: Chondrosarcoma of the hyoid bone is a rare disease of which only 14 cases have been reported until now. Patients with this disease have no sexual or racial preponderance, and most presented with a mass in the upper neck which has splotchy calcification in radiologic imaging without enhancement. The preferred treatment is wide excision. Conclusion: Because chondrosarcoma have indolent growth, are locally noninvasive, and appear encapsulated during operation, they may be mistaken for a benign mass and conservatively resected. On the other hand, incomplete tumor resection may lead to recurrence, which is associated with increased risk of dedifferentiation and histologic grading of tumor. Surgeons should approach this surgery with caution.     

Bauchdeckenmetastasen als Komplikation der PEG-Anlage bei Karzinomen des oberen Aerodigestivtraktes

Percutaneous endoscopic gastrostomy (PEG) has become an important adjunct in the care of head and neck cancer patients. In the literature of the last 10 years, 16 cases of abdominal wall metastasis after PEG implantation were reported. We performed 387 PEG procedures in patients with head and neck cancers. In this paper, we describe two patients with advanced head and neck cancers who underwent PEG prior to cancer therapy and developed metastatic cancer at the PEG site 3 or 4 months later. Although the mechanism of spread cannot be confirmed, direct seeding from passage through the cancer seems likely. Methods of establishing enteral access which avoid tumor-contaminated fields, such as the use of an overtube during conventional PEG or PEG procedure after tumor resection, may be appropriate in head and neck cancer patients. Another possibility of origin is the hematogenous spread of cancer cells from metastases on the abdominal wall.     

Giant cell tumor of the larynx: a case report and review of the literature

Giant cell tumors are benign tumors commonly found in the long bones. Rarely, they may occur in the larynx, and patients with such tumors may present with hoarseness and anterior neck swelling. Since Wessely reported the first case of laryngeal giant cell tumor in 1940, 30 cases have been identified. Herein, we present a case of a 31-year-old man with giant cell tumor of the larynx successfully treated via the hemilaryngectomy approach.     

Modified neck dissection for metastatic nonseminomatous testicular carcinoma.

OBJECTIVE: To examine the role of neck dissection in the treatment of metastatic stage 3 nonseminomatous germ-cell tumors (NSGCTs) of testicular origin. METHOD: A retrospective review was made of 45 patients with metastatic NSGCT who underwent 48 unilateral and 3 bilateral neck dissections. Only level III-VI nodes were dissected, often with concomitant or staged mediastinal dissection, thoracotomy, and/or retroperitoneal node dissection. Occasionally, resection of the clavicle, jugular vein, or subclavian artery, or a combination of these, was required to eradicate the disease. RESULTS: There were only four instances of recurrence in dissected necks. There was one case of dedifferentiation of mature teratoma to adenocarcinoma Patients who were followed for a mean period of 32 months had a disease-free survival of 72%. Prognosis for patients with stage 3 disease but negative preoperative tumor markers (alpha-fetoprotein and human chorionic gonadotropin) was excellent, with 97% of these patients having no evidence of disease at follow-up. Factors having a negative impact on survival included positive tumor markers, elements of germ-cell cancer in excised nodes, and a neck mass that represents late relapse of disease. CONCLUSION: Modified neck dissection has a demonstrated role in the treatment of metastatic NSGCT. It prevents reversion of mature teratoma to malignant germ cell tumor with minimal morbidity. Aggressive resection of disease is indicated, often in conjunction with thoracic surgery, to eradicate disease extending into the chest. There is an excellent prognosis in patients with negative preoperative serologic tumor markers.     

Presence of malignant tumor cells in persistent neck disease after radiotherapy for advanced squamous cell carcinoma of the oropharynx is associated with poor survival

Non-surgical therapy consisting of external beam radiation with or without chemotherapy is an effective treatment for patients with squamous cell carcinoma (SCC) of the oropharynx with advanced neck disease (N2a or greater). However, many of these patients have to undergo a neck dissection for clinically persistent regional disease. It is reported that nearly 50% of the neck dissection specimens contain residual viable tumor cells that may indicate partial radiation failure and as a consequence poor survival. In order to address the significance of this finding, we conducted a nonrandomized retrospective study, including 35 patients who underwent definitive radiation therapy followed by either a radical or modified radical (RND/MRND) or a selective neck dissection (SND) for clinically persistent neck disease 6 weeks after completing therapy for stage III/IV SCC of the oropharynx (base of the tongue =15, tonsil =12, soft palate =7 and pharyngeal wall =1). All neck dissection specimens were reviewed according to histological criteria indicating viable residual tumor. We observed an increased relative risk (RR) for local and regional failures in the patient population with viable cancer cells in the post-irradiation neck specimens (RR=6.7 and 4.1, respectively). The presence of malignant tumor cells in residual disease in the neck correlated with poor disease-specific and overall survival ( P =0.03 and P =0.01, respectively). Of note, the extent of neck dissection did not improve the disease-free or overall survival in this patient population ( P =0.5 and P =0.6, respectively). In conclusion, the presence of viable cancer cells in radiated neck nodes is a novel prognostic marker for disease-specific survival in patients treated for SCCs of the oropharynx with advanced neck disease and may serve as an identifier for patients who will benefit from post-treatment chemoprevention.     

Elevated Arginine Vasopressin Levels in Squamous Cell Cancer of the Head and Neck

The reported effectiveness of single tumor markers (TMs) associated with squamous cell cancer of the head and neck ranges from 15% to 71%, with most studies reporting sensitivity no higher than 50%. An increased incidence of the syndrome of inappropriate secretion of antidiuretic hormone or arginine vasopressin (SIADH) in patients with head and neck cancer has been reported. Serum arginine vasopressin (AVP) was studied as a possible TM in these patients. Sixty-three patients with squamous cell carcinoma of the head and neck determined as potentially curable were prospectively evaluated before treatment and compared to 17 patients with apparent cure of head and neck squamous cell cancer who served as controls. Serum AVP levels were obtained and determined by radioimmunoassay in the preoperative period and 1 week postoperatively in 15 patients. Thirty-four patients were staged as T4, 26 as T3, and 3 as T2. Twenty-one (33%) of the 63 patients had no neck involvement. Twenty-four (38%) of 63 patients had elevated serum AVP levels corrected for serum osmolarity. Of the 15 patients evaluated before and after surgery, 8(53%) had elevated serum AVP levels preoperatively. Of these 8 patients, 3 had reduction in AVP levels and 5 had complete normalization after 1 week. The results obtained for serum AVP do not exceed results of other TMs reported. AVP may also not be as specific as other TMs for cancer of the head and neck. Our group with AVP sampled postoperatively is too small for us to draw conclusions, but reduction of its levels after treatment in all patients may be significant. These preliminary results indicate that further evaluation of AVP during the posttreatment course in a larger number of cases, and perhaps with other TMs as well, is warranted.     

Liposarcoma of the neck. Report of a case

A case of lipoblastic liposarcoma of the neck is presented. The case is that of a 5-year-old female who underwent a modified neck dissection with a good result. A review of the literature reveals that this is an extremely rare tumor of the neck. It is usually found in the lower extremities, predominantly in adult males. Surgery is the treatment of choice. Lipoblastic liposarcoma is an extremely rare tumor when it occurs in the pediatric neck. Hudson and Saunders in their studies have shown that only 3 patients with this tumor have been reported since 1944. When a 5-year-old female presented with this primary neck mass, questions of diagnosis and treatment were raised. The following case report and discussion will demonstrate the diagnostic methods as well as the course of therapy followed in this type of lesion.     

Management of brachial plexus tumors

Three cases are reported of brachial plexus tumors that presented as a lump in the neck. Problems that arise when faced with such a diagnosis are discussed. A suggested protocol of management of these cases is described. The possibility of a brachial plexus tumor should be included in the differential diagnosis of a patient presenting with a mass in the neck.     

Alveolar soft part sarcoma of the larynx

Alveolar soft part sarcoma (ASPS) is a rare malignancy. It has generally a poor prognosis. Survival depends on the presence of metastases. Approximately, one-fourth of the cases are encountered in the head and neck region, mostly in the orbits and tongue. Surgery is accepted as the most effective treatment, radiotherapy and chemotherapy may be used as adjuvant treatments. Since it is a highly vascular tumor, profuse bleeding may occur during surgery. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor. To our knowledge, only three cases of laryngeal ASPS have been previously reported in the English literature.     

Malignant peripheral nerve sheath tumor of the parotid gland

Malignant peripheral nerve sheath tumor (MPNST) has been defined as any malignant tumor arising from or differentiating toward cells of the peripheral nerve sheath. We treated a case of MPNST arising from the right parotid gland that showed a highly aggressive course. We reviewed the English-language literature published since 1990 and found 142 cases of head and neck MPNST reported within the past 13 years. The results of the review suggested that MPNSTs may arise from any organs of the head and neck. Immunohistochemical analysis of various neural markers plays a significant role in the evaluation of the histologic diagnosis. Curative treatment based on radical resection of MPNSTs of head and neck origin is more difficult than treatment of MPNSTs of other origins.