Management of advanced cervical metastasis using intraoperative radiotherapy

Seventy-five patients who had advanced cervical metastasis with possible invasion of the deep muscles or carotid artery were approached with aggressive resection and intraoperative radiotherapy (IORT). All metastatic nodes were greater than 3 cm, 65% were fixed on clinical examination, and 35% involved the carotid artery. Forty-six (61%) of the patients had previously received irradiation. Fifteen of the patients required extended neck dissections with carotid resections and grafting. After the resection an average single dose of 2000 cGy of electron beam IORT was delivered. At 2 years, the local control rate within the IORT port was 68% and the absolute survival rate was 45%. Local control rates for close and microscopic margins (76% and 73%, respectively) were significantly better than the control rate for gross residual disease (25%, P<.05). The combination of extended neck dissection, including carotid artery resection if necessary, and IORT appears to offer improved control.     

Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid papillary carcinoma

We present a case of solitary cystic lymph node metastasis from an occult thyroid papillary carcinoma mimicking a lateral cervical cyst, and a case of thyroid papillary carcinoma with a true lateral cervical cyst. Based on a comparison of the radiographical findings of the two cases, differential diagnosis between cystic lymph node metastasis of papillary carcinoma and branchial cyst is discussed.     

Management of extensive cervical nodal metastasis in nasopharyngeal carcinoma after radiotherapy: a clinicopathological study.

OBJECTIVES: To evaluate the efficacy of afterloading brachytherapy following radical neck dissection (RND) in the management of extensive cervical lymph node disease in nasopharyngeal carcinoma after radiotherapy; and to examine prospectively prognostic factors and the pathologic behavior of neck disease. PATIENTS: Twenty-seven patients with nasopharyngeal carcinoma who had extensive cervical lymph node metastasis following external radiotherapy were treated with RND. Thirteen of them also underwent afterloading brachytherapy with iridium wire (Ir 192). The RND specimens of the 27 patients were also examined with step serial whole-specimen sectioning. RESULTS: All patients survived and their wounds healed primarily. Pathologic examination revealed 183 tumor-bearing lymph nodes that contained tumors in the neck: level I, 4% (8/183); level II, 53% (96/183); level III, 34% (62/183); level IV, 5% (9/183); and level V, 4% (8/183). Extracapsular tumor extension was seen in 84% of patients. Multivariate analysis identified the number of tumor-bearing lymph nodes detected in the specimens to be the only significant factor that affected control of disease. Although the neck disease in the group of patients who had afterloading brachytherapy was more extensive, the 3-year actuarial tumor control for the groups with and without brachytherapy were 60% and 61%, respectively. CONCLUSIONS: Recurrent cervical lymph nodes after radiotherapy in nasopharyngeal carcinoma are extensive and RND is mandatory for a successful salvage. When the nodal metastasis infiltrate or adhere to surrounding tissue, afterloading brachytherapy with iridium wire can provide satisfactory local tumor control.     

"Collision" metastasis from unknown primary squamous cell carcinoma and papillary microcarcinoma of thyroid presenting as lateral cervical cystic mass

We report an unusual case of "collision metastasis". In a single lymph node, we found a metastatic mass composed of two immunohistochemically distinct components originating from two primary tumors: a papillary microfollicular thyroid cancer and an unknown primary squamous cell carcinoma. The clinical features and immunohistochemical profile are reported. Collision phenomena in oncology are extremely rare and pose diagnostic and management challenges which are discussed.     

Advanced cervical metastasis involving the carotid artery

PURPOSE OF REVIEW: This paper will review recent reports of the surgical management of the carotid artery when cancer is adherent to it and will highlight the author's experience at Clarian Health Partners in Indianapolis. RECENT FINDINGS: Recent trends in treating metastatic neck cancer with chemoradiation initially and reserving surgery for the treatment of residual or recurrent disease has tasked the head and neck surgeon with extirpating cancer in significantly altered tissue with loss of tissue planes and scarring that conceals the extent of cancer spread. Cancer that is adherent to the carotid presents a treatment dilemma to the surgeon, given that historically the local control and survival has been dismal and the complications of surgery are high. SUMMARY: The heavy burden of deciding to resect the carotid artery involved with recurrent or residual cancer should be balanced against the natural history of the disease process if not it is treated. It requires detailed understanding by the patient and family as well as coordination among the interventional radiologist, anesthesiologist, radiation oncologist, intensivist, and head and neck surgeon.     

Sinonasal adenoid cystic carcinoma with widespread symptomatic bony metastasis

Adenoid cystic carcinoma is a fairly uncommon salivary neoplasm of the head and neck. These lesions often progress insidiously, and they have a propensity for early perineural spread and bony invasion. Distant metastasis to the lungs is fairly common and is usually fatal. We report a rare case of adenoid cystic carcinoma in a patient who on initial evaluation had widespread bony metastasis but no pulmonary involvement.     

外耳道腺样囊性癌侵犯中耳、颞叶且伴颈部淋巴结转移一例报告

正1病历资料1.1一般资料患者,女,53岁。患者2016年初出现左耳流脓,伴听力下降,抗炎及局部用药等治疗后病情仍反复。拟"慢性化脓性中耳炎"于2016年5月25日入住当地医院治疗,中耳乳突CT示"左侧乳突气房、乳突窦、鼓室内可见软组织样密度影填充,骨质未见明显破坏",专科查体:左外耳道见脓性分泌物,伴肉芽生长,鼓膜窥视不清。2016年5     

囊性颈部转移癌临床分析

目的探讨以囊性肿块为首发症状的头颈恶性肿瘤的临床特点和治疗方法。方法对6例以囊性肿块为首发症状,最终明确为头颈部恶性肿瘤颈淋巴转移的患者临床资料进行分析。结果6例中有4例原发灶为甲状腺乳头状癌,1例原发灶为扁桃体癌,1例原发灶为鼻腔内翻性乳头状瘤恶变。结论以囊性肿块为首发症;映的头颈部恶性肿瘤临床原发灶易被漏诊,应采用多种诊断方法明确诊断,治疗应根据原发灶的病理类型决定。     

Computed tomography of cervical cystic hygroma in the neck

The computed tomography findings in 4 infants and children with surgically proved cystic hygroma of the neck were reviewed and correlated with pathologic specimens. Cervical cystic hygroma characteristically appears on CT scan as a multiloculated cystic mass with smooth septa of variable thickness, which enhances uniformly following bolus injection of contrast media administration. This CT pattern can usually be used to differentiate cystic hygromas from other cervical masses such as soft tissue sarcomas. CT is also helpful in determining the extent of the lesion prior to the surgery and in assessing the recurrences.     

Congenital cervical choristoma of the neck mimicking cystic lymphangioma

IntroductionChoristoma is a mass presenting normal histology, but in an abnormal location. Cystic choristoma is rarely reported in the head and neck region. Neonatal cystic masses in the neck suggest usually correspond to a diagnosis of cystic lymphangioma.Case reportWe report a case of a congenital cystic choristoma of the neck clinically and radiologically mimicking cystic lymphangioma.DiscussionCongenital cystic choristoma is an extremely rare lesion, essentially described in neonates, composed of various types of tissues. The diagnosis of congenital cystic choristoma may be suggested on imaging and must be confirmed by histopathological examination. Treatment consists of complete surgical resection.     

Nasopharyngeal low-grade papillary schneiderian carcinoma with cervical metastasis

Low-grade papillary Schneiderian carcinoma (LGPSC) is a rare and newly described type of cancer arising from the Schneiderian epithelium. Owing to cellular atypia, it is difficult to differentiate this type from other papillomas and malignancies. Although this condition remains unclear, it is associated with mortality and recurrence. Therefore, treating physicians should be aware of the possibility of LGPSC for prompt diagnosis and treatment. In this article, we present an additional case of nasopharyngeal LGPSC with cervical lymph node metastasis and reviewed the 14 cases reported thus far in the literature. A 76-year-old female was referred to our department for detailed examination of nasopharyngeal and cervical lymph node tumors detected by positron emission tomography-computed tomography. Based on the biopsy of the nasopharyngeal tumor, we suspected LGPSC. Considering the clinical course and pathological findings, the patient was diagnosed with cervical lymph node metastasis through neck dissection. We performed radiotherapy for the primary lesion of the nasopharynx, which led to the disappearance of the tumor. After 13 months following the radiotherapy, the patient died from a recurrence of retroperitoneal liposarcoma without the recurrence of LGPSC.     

Primary cutaneous adenoid cystic carcinoma with regional lymph node metastasis

Primary cutaneous adenoid cystic carcinoma (PCACC) is a particularly rare variant of sweat gland carcinoma with characteristics of indolent and progressive course and high incidence of perineural invasion and local recurrence. However, regional lymph node metastasis in PCACC is exceedingly rare and its prognostic implication is unknown. Only two previous cases of recurrent scalp PCACC were reported to be associated with cervical lymph node metastases at 42 months and 20 years, respectively, after the initial treatment. We present a case of PCACC occurring in the left parotid region with regional neck lymph node metastasis in a 64-year-old man. Because the occurrence of lymph node metastasis seems to be associated with recurrent PCACC, we suggest that neck dissection may be included in the treatment for recurrent PCACC patients.     

超声检查对头颈部恶性肿瘤颈部淋巴结转移的诊断价值

探讨超声检查诊断颈淋巴结转移的准确性及对颈部隐戒性淋巴结转移的诊断价值。方法应用双盲法对５５例行颈廓清术患者的术前触诊,超声检查及术后病理检查进行对比分析 。     

下咽癌颈淋巴结转移区域探讨

目的研究下咽癌颈淋巴结转移区域的特点及术后治疗策略。方法回顾性分析2004年7月～2008年7月于我科住院治疗的18例下咽癌患者的临床资料,18例患者均行手术治疗,术前未行放疗或化疗,将术中肿瘤原发灶及根治性颈廓清术中的颈淋巴结标本按区域标记逐一进行病理观察,确定肿瘤原发部位及颈淋巴结转移区域。术后随访3～5年,观察淋巴转移与患者的关系。结果 18例下咽癌颈淋巴结转移率为88.9%（16/18）;颈淋巴结转移的主要区域为LevelⅡ区、LevelⅢ区,转移率分别为73.1%、69.2%;其次为LevelⅣ区8.3%,未发现LevelⅠ区、LevelⅤ及LevelⅥ区淋巴结转移。结论下咽癌颈淋巴结转移率较高,转移区域同侧为主,以LevelⅡ、LevelⅢ区常见。颈淋巴结位置的下移和转移淋巴结的直径与患者的预后呈正相关。     

下咽癌颈淋巴结转移区域探讨

目的 研究下咽癌颈淋巴结转移区域的特点及术后治疗策略,改善预后.方法 回顾性分析2002年7月～2008年7月于我科住院治疗的35例下咽癌患者的临床资料,29例患者均行手术治疗,且术前未行放疗或化疗,将术中肿瘤原发灶及颈清扫术中的颈淋巴结标本按区域标记逐一进行病理观察,确定肿瘤原发部位及颈淋巴结转移区域.通过随访3～5年,观察转移及预后.结果 29例下咽癌总的颈淋巴结转移率为86.2％(25/29),颈淋巴结转移的主要区域为Level Ⅱ区、Level Ⅲ区,转移率为73.8％、69.0％,其次为Level Ⅳ区7.7％,未发现Level Ⅰ区、Level Ⅴ及LevelⅥ区淋巴结转移.结论 下咽癌颈淋巴结转移率较高,转移区域同侧为主,以Level Ⅱ、Level Ⅲ区常见.随着颈淋巴结位置的下移及转移淋巴结直径的增大,患者的预后越来越差.     

成人颈部囊性水瘤1例诊治经验

颈部囊性水瘤是淋巴管瘤的一种,是发生在淋巴系统的良性肿瘤〔1-2〕,常见于2岁以下的儿童,成人颈部囊性水瘤非常罕见〔3-4〕。现将上海市嘉定区中心医院2012年6月收治的1例成人患者报告如下。1资料与方法患者,女,60岁。3年前无明显诱因下出现咽部不适,偶有阵发性刺痛。当时未予重视,未正规治疗。近来患者自觉症状加重,遂来我科就诊。体检：右颈部可扪及局限性隆起,上界为右侧下颌角,下界为舌骨水平,外侧为右侧胸锁乳突肌后缘,内侧为右侧气管旁线。肿块质软,不易活动。     

Management of chronic sinusitis in cystic fibrosis

Chronic rhinosinusitis is extremely common in patients with cystic fibrosis. It causes numerous problems in these patients and can put them at risk for life-threatening illness. Potential problems include nasal obstruction, congestion, sinus pain and pressure, infection (usually with Pseudomonas organisms), hyposmia or anosmia, and the seeding of bacteria into the lower respiratory tract. Cystic fibrosis patients with chronically infected sinuses are at increased risk for pneumonia following lung transplantation. A prophylactic protocol has been developed for the management of chronic sinusitis in patients with cystic fibrosis. These patients are fully evaluated at the Nasal Dysfunction Clinic of the University of California, San Diego (UCSD), Medical Center. Based on the results of the evaluation, they are treated with endoscopic sinus surgery, partial middle turbinectomy, septoplasty, and a large middle meatal maxillary antrostomy. Surgery is followed by a rigorous regimen of pulsatile hypotonic saline nasal irrigation to wash away tenacious cystic secretions. Tobramycin (Nebcin®) is given once daily in the nasal irrigant to inhibit the growth of Pseudomonas organisms. At the USCD Nasal Dysfunction Clinic, this prepulmonary transplantation protocol is now used in all cystic fibrosis patients with chronic sinusitis.