Breast carcinoma metastatic to the nasopharynx

A case report of a patient with adenocarcinoma of the breast with metastasis to the nasopharynx is described. The patient presented initially with pulmonary metastasis followed later by metastasis to the left jugulo-digastric lymph nodes. A prominent but asymptomatic nasopharyngeal mass was concomitantly discovered on head and neck examination. Three months later, symptoms of panhypopituitarism developed. Invasion of the base of the skull and pituitary were documented. Patients with adenocarcinoma of the breast and high cervical node metastasis should have a thorough otolaryngologic and head and neck evaluation. Metastatic carcinoma to the nasopharynx is an extremely rare occurrence. Only two cases of bronchogenic carcinoma of the lung and two cases of hypernephroma metastatic to the nasopharynx have been reported in the literature (Bernstein et al., 1966). We present what we believe to be the first case of metastatic adenocarcinoma of the breast to the nasopharynx.     

Hypernephroma metastatic to the head and neck

Six cases of hypernephroma metastatic to the head and neck are presented (larynx, tongue, temporal bone, supraclavicular region, nasopharynx, and occipital region) and the literature is reviewed. Hypernephromas that metastasize to the head and neck often simulate primary tumors, and the otolaryngologist must be aware of this diagnostic possibility, especially when dealing with paratracheal masses. Surgical removal of accessible solitary metastasis is recommended and offers the best palliation.     

Metastatic renal carcinoma to the parotid gland

A case of renal carcinoma metastatic to the left parotid gland is presented. A 60-year-old male patient developed a painful mass in his left parotid region one and a half years after he had undergone a left nephrectomy operation for renal carcinoma. The mass was excised surgically. The histopathological diagnosis was metastatic renal carcinoma. From a review of the literature, it is apparent that unlike most of the cases reported, this one had a very aggressive nature. The clinical presentation of the metastasis, and the factors determining the prognosis in cases of metastatic renal carcinoma to the head and neck are discussed.     

Histopathological findings in parotid gland metastases from renal cell carcinoma

Metastatic tumours involving the parotid gland arising from non-head and neck origin are rare. Immunohistochemistry has improved the differential diagnosis of these lesions. Current immunohistochemical markers allow the distinction between a number of potential primary tumours (e.g., lung, kidney and breast). We present the clinical and histomorphological features of three renal cell carcinoma (RCC) patients presenting with a parotid mass, review the literature of various non-head and neck malignancies metastasizing to the parotid gland, and discuss their differential diagnosis. Two females and one male, aged 58 to 76 years, presented with a parotid tumour of renal cell origin. In one case, the parotid mass was the first clinical manifestation. In the two other cases, a nephrectomy had been performed 5-9 years earlier because of RCC. The cases showed a highly vascular parotid lesion causing difficulty in interpretation of the fine needle aspirate. Two patients underwent a superficial parotidectomy and one patient an open biopsy of the parotid gland tumour. Immunohistochemical stainings for vimentin, CD10 and PNRA were positive suggesting renal cell origin, which was later confirmed. Clinical and radiological evaluations and diagnosis by fine needle aspiration may prove difficult partly due to the vascular nature of parotid metastasis of renal cell carcinoma. Immunohistochemical staining is useful in identifying the primary tumour.     

Malignant lymphoma in the head and neck associated with benign lymphoepithelial lesion of the parotid gland

Lymphoepithelial lesion is a benign lymphoproliferative disease occasionally arises in the salivary glands, but association with malignant diseases or autoimmune diseases has also been discussed. We herein present three cases of malignant lymphoma arose in the parotid gland and the lacrimal gland, following parotid surgery for benign lymphoepithelial lesion (BLEL) of the parotid gland. Two cases had mucosa associated lymphoid tissue (MALT) lymphoma in the parotid gland; one arose in the ipsilateral parotid gland as a recurrent swelling, and the other arose in the contralateral parotid gland of the previous BLEL surgery. The third case of malignant lymphoma arose in the lacrimal gland on the ipsilateral side, and the following contralateral parotid gland remained BLEL. All three patients were female, and one patient had a past history of Sj?gren's syndrome and Hashimoto's disease. All three patients were treated by chemotherapy and one patient received additional radiotherapy. To follow-up lymphoproliferative diseases in the salivary glands such as BLEL, careful observation should be made on the same gland, other major salivary glands, and other organs in the head and neck, especially in females with autoimmune diseases.     

The lymphatic system of the major head and neck glands in rats

Many studies concerning therapy and also investigations on lymphogenic metastatic spread of head and neck malignancies require animal models. This article completes the existing findings with regard to the lymphatic system of the head and neck region of the rat. Investigations (light microscopy, immuno-histochemistry, enzyme histochemistry, lympho-graphy) on architecture, distribution and density of the intraglandular lymphatic flow of the major head and neck glands (infraorbital lacrimal gland, extraorbital lacrimal gland, Harderian gland, parotid gland, major sublingual gland, mandibular gland and thyroid gland) in rats were performed. Architecture of the seven major head and neck glands in rats do not differ from other regions of the upper aerodigestive tract. While the Harderian gland shows the highest density of lymphatics, within the major sublingual gland only scare lymph vessels could be identified. Distribution and density of initial lymphatics influence directly the transmission of inflammatory and malignant diseases. The presented results are the morphologically and anatomically basis to initiate further investigations in the rat animal model emphasizing special questions concerning the lymphatic system of the major head and neck glands e.g. lymphatic drainage and new treatment concepts in cases of lymphogenic metastatic spread.     

Metastasis in submandibular gland from a leiomyosarcoma of the uterus

Two general types of metastases should be distinguished in metastatic salivary gland tumors: one of them are tumors originating in the head and neck region, and the other are tumors from distant tumor sites. Distant metastasis affecting the submandibular gland are a rare entity. We report a case of the uterus leiomyosarcoma which metastatised in the submandibular gland.     

Metastases of Melanoma to Head and Neck Mucosa: A Report of Short Series

ObjectivesMetastasis of melanoma to the head and neck mucosa is a very unusual condition. The aim of this study was to report four cases of patients with metastatic melanoma in the head and neck mucosa treated at a single institution.MethodsClinical data were obtained from the medical records. All cases were histologically reviewed to confirm the diagnosis, and immunohistochemical reactions were performed in the cases submitted to biopsy. ResultsAll patients were males and the mean age was 40.5 years old. The sites of the metastatic tumors were gingival mucosa, floor of the mouth, oropharynx, and larynx. Two tumors appeared as submucosal nodules with normal color; one lesion was a blackish nodular lesion, and one was shown to be an ulcerated lesion. The size of tumors ranged from 2.0 to 4.0 cm. All patients had developed systemic disease at time of diagnosis of metastatic tumor in the head and neck mucosa. Survival rates ranged from 2 to 19 months after the diagnosis of the metastatic mucosal melanoma in the head and neck region.ConclusionAlthough rare, patients with melanoma must be closely and regularly followed up, with careful routine examination of head and neck, because metastatic tumors in this region seem to be part of a lethal widespread metastatic disease.     

Management of cystic cervical metastasis

An adult older than 40 years present with a cystic lump in the upper neck should be considered at risk of having an underlying malignancy of the head and neck-a mucosal squamous cell carcinoma or a papillary thyroid carcinoma. Although the likelihood of malignancy is small, should the diagnosis of malignancy be confirmed pathologically, this consequential diagnosis will result in devastating physical and psychologic upset to the patient and their caretakers, the treating surgeons, and possibly many other clinical groups. It is therefore recommended that all such patients be investigated by radiologic imaging-CT/MRI and fine needle aspiration cytology, followed by panendoscopy of the head and neck, which includes an ipsilateral tonsillectomy biopsy and an excision biopsy of the cystic neck lesion. Should the lesion prove to be an isolated cystic metastatic squamous cell carcinoma, a neck dissection should be performed with or without adjuvant radiotherapy. Should the lesion prove to be a metastatic papillary thyroid carcinoma, a total thyroidectomy and neck dissection should be performed. In general, patients with cystic metastasis have a better prognosis than patients who present with a noncystic neck mass.     

Three cases of renal cell carcinoma metastasizing to the head and neck

Renal cell carcinoma (RCC) tends to metastasize hematogenously, although metastasis to the head and neck is rare. We report 3 cases of RCC head and neck metastasis within the last 6 years. CASE 1: A 74-yearold woman presented with cervical metastasis from RCC 4 years after right total nephrectomy, involving modified neck dissection. She later had additional surgery and radiation for further distant metastases, survived almost 5 years after the first neck metastasis. CASE 2: A 60-year-old man showed metastatic RCC in the right parotid gland 3 years after right total nephrectomy, involving superficial parotidectomy. CASE 3: A 54-year-old man presented with a metastasis lesion from RCC to the right maxillary sinus 7 years after left total nephrectomy, involving total maxillectomy. Distant metastasis reportedly often occurs long after initial primary RCC treatment. Physicians considering metastatic RCC in differential head and neck diagnosis and resection could conceivably promote better prognosis.     

Metastatic renal cell carcinoma to the head and neck

OBJECTIVES: The objectives of the study were to present four cases of renal cell carcinoma (RCC) metastatic to the head and neck, to recognize the appearance on radiographic studies, to understand the importance of preoperative embolization, and to review the results of treatment. STUDY DESIGN: Retrospective review of patients diagnosed with metastatic RCC to the head and neck. METHODS: The records of four patients diagnosed with metastatic RCC at a tertiary medical center over a 5-year period from 1996 to 2001 were reviewed and analyzed for demographic and outcomes data. RESULTS: Metastatic RCC to the head and neck was seen in the following locations: nasal cavity, lower lip, hard palate, tongue, and maxillary sinus. Presenting signs were loose upper molars, dysphagia, nasal obstruction, lower lip lesion, recurrent epistaxis, and foul nasal drainage. Histological studies confirmed metastasis of RCC in all four patients. Treatment consisted of preoperative radiation therapy, embolization, and local excision with adjunct chemotherapy. CONCLUSIONS: Metastatic RCC to the head and neck is rare but can have serious consequences if not recognized before biopsy. We present several treatment options with local excision as the primary mode of treatment.     

Malignant Melanoma Metastatic to the Tonsil

Metastasis to the oral cavity from melanoma arising in distant sites is very rare. The authors present three cases of melanoma metastatic to the palatine tonsil: two were cutaneous melanomas and one arose from the mucous membrane of the hard palate. Fewer than 30 cases of metastatic melanoma to the palatine tonsil have been reported, and none have been from mucosal melanoma originating from another mucosal primary site in the head and neck. From this perspective, one of the cases in this article is unique. The authors present clinical histories of the three cases of melanoma metastatic to the palatine tonsil. Two patients were still alive a substantial time after treatment. The case presentations indicate that careful examination of the head and neck should be part of the routine follow-up examination in all melanoma patients.     

Malignant mesenchymoma of the larynx

A case report of a primary laryngeal malignant mesenchymoma, a very rare head and neck and even rarer laryngeal lesion, is reported. In this case, an 85-year-old man, who had undergone several panendoscopies and biopsies that were non-diagnostic, subsequently succumbed to pulmonary metastases and died from respiratory failure. At autopsy, tumour cells were demonstrated to constitute both bone and striated muscle cell types. As the tumour cells differentiated into two types of specialized cells from one type of embryonal tissue, the diagnosis of malignant mesenchymoma was established.     

头颈部原发性结外淋巴瘤146例临床分析

目的探讨原发于头颈部的结外型淋巴瘤的临床特点和误诊原因，为该病的诊治提供经验。方法选取2001-2011年诊治的146例原发于头颈部并经病理证实为结外型淋巴瘤患者，对其临床资料进行回顾性分析。结果146例患者根据病检结果及病情采取不同的治疗方案；其中3年生存率为55％，5年生存率为41％。不同部位及不同病理类型生存率有明显差异。结论原发于头颈部的结外型淋巴瘤可发于多个部位，部分位置隐蔽，不易发觉，临床症状无特异性，及时针刺活检和术中快速病理切片可提高诊断率和患者生存率。     

Clear cell adenocarcinoma of the base of the tongue: a case report and review of the literature

Clear cell adenocarcinoma is an extremely rare tumor of the head and neck region. We report a case of a 75-year-old Caucasian woman with a 10-day history of hemoptysis but with no pain or other significant symptoms. A head and neck computed tomography scan with contrast medium showed an irregular, soft-tissue-like, irregularly enhanced lesion of the base of the tongue extending to its posterolateral portion. The tumor reached the lateral wall of the oropharynx, which showed a nonhomogeneous aspect. The patient underwent resection of the tumor via a conservative transmandibular approach. A clear cell adenocarcinoma of the base of the tongue is rarely a primary malignant lesion; it is more frequently a secondary lesion from a metastatic renal tumor. Because of this neoplasm's relatively slow growth rate and low incidence of metastasis or local recurrence, the gold standard of treatment is complete excision of the tumor with a sufficient tumor-free margin.     

Chondrosarcoma of the hyoid bone

Chondrosarcoma of the head and neck is relatively rare. We report the sixth case known to us in which the chondrosarcoma had originated in the hyoid bone. The patient, a 66-year-old man, underwent surgery. The resected tumour was a 5 cm encapsulated lesion composed of lobulated, firm, gray-white tissue. Histologically it showed mature chondrocytes without capsular invasion. There was high cellularity and a few binucleated chondrocytes. Although the tumour grade was prognostic significance, our literature review of the five other cases suggests that the location of the primary lesion and the adequacy of its resection to be more important. Our patient continues to do well 15 months post-operatively. However, long-term follow-up is essential as recurrences have been reported even after eight or 10 years.     

Metastatic thyroid carcinoma of the mandibule.

A case of metastatic papillary carcinoma to the mandible is presented. Though relatively rare, metastatic tumours of the mandible should be included in the differential diagnosis of the tumours in the parotid region. For the primary site; being in the cervicofacial region, the thyroid gland must be considered by the head and neck surgeon.     

头颈肿瘤术后并发颈动脉破裂4例报告

目的：探讨头颈部恶性肿瘤侵犯颈动脉的手术治疗方法。方法：对4例颈动脉与转移瘤粘连患者，采用从颈动脉壁上剥离切除肿瘤保留血管的术式。结果：术后1周内4例都发生了颈动脉破裂，1例经颈动脉修补术后再发血管破裂出血死亡，3例经行颈动脉结扎术后存活。结论：对于肿瘤累及颈动脉的患者术前应作好结扎切除颈动脉的准备；术中若发现肿瘤与血管壁粘连，则应结扎血管连同肿瘤一并切除；一旦术后并发颈动脉破裂，则应结扎之，而不宜行修补术。     

Responsibilities of the otorhinolaryngologist in the follow-up of malignancies of the head and neck

The aims of follow-up of head and neck cancer patients are the detection of new tumour manifestations, management of impairments after tumour therapy, psychological care and the evaluation of therapeutic efficacy. The extent, success and cost-benefit ratio of follow-up are currently under discussion. We recommend interdisciplinary cooperation between the relevant specialists, such as oncology and radiotherapy, together with the otorhinolaryngologist for reasons of cost-efficacy and improvement of long-term results. We present a follow-up schedule for patients with head and neck squamous cell carcinomas, which are the by far most common manifestation. We recommend a standardized protocol, which should be individualized depending on tumour site, size, treatment and therapeutic options in the case of tumour recurrence. The most common salivary gland malignancies are also discussed. The objective is to increase the efficacy of follow-up in patients with head and neck cancer.     

Carcinoma neuroendocrino primario de la piel,carcinoma de células de Merkel. Casuística 1991-2012

Introduction and objectivesMerkel cell carcinoma was first described by Toker in 1972. It is an uncommon, primary neuroendocrine skin carcinoma which appears in the dermoepidermic area, grows fast, is very aggressive and has a poor prognosis. The aim of this work is to highlight the importance of this tumour, which develops mainly in the skin of the head and neck area, and whose prevalence has increased in recent years.Material and methodWe gathered data on 16 patients suffering cutaneous neuroendocrine carcinoma treated at our hospital between September 12, 1991 and July 13, 2012. We indicated the age and gender of patients. We described the area where the tumour was located, indicating the size in millimetres, according to the major axis of the lesion.ResultsMost of the patients studied were over 70 years old, except for one who was 55. The highest frequency of cases appeared among patients aged over 80 years. In the cases studied, when the tumour appeared in the head and neck region (10/16), its location could be nasal-lateronasal, cheek-malar, upper eyelid, frontal or mandibular. The major axis of the lesion ranged between 7 and 35 mm. Unlike with epidermoid or basocellular carcinomas, recurrence and ganglionar metastases were common. Immunohistochemical (CK20) tests are essential for a correct diagnosis. Treatment is usually surgical and occasionally followed by radiotherapy and chemotherapy.ConclusionThis carcinoma is not a very common skin tumour. It appears in old age, in the head and neck region in 50% of cases and often leads to exitus.