Carcinoma

Carcinoma ex pleomorphic adenoma of the maxillary sinus: A case report

December 31, 2012     Suja Sreedharan, MS; Kishore Chandra Prasad, MS, FACS; Mahesh Chandra Hegde, MS; Kausalya Sahoo, MS; and Arathi Alva, MS
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Abstract

A 52-year-old woman presented to the ENT clinic with a huge swelling on the right side of her face that had originated 6 years earlier. The mass was ultimately diagnosed as a carcinoma ex pleomorphic adenoma of the maxillary sinus. Carcinoma ex pleomorphic adenoma itself is uncommon, and its origin in the maxillary sinus is very rare. We discuss the presentation, histopathologic picture, and management of this case.

Traumatic thyroid hematoma associated with thyroid carcinoma

September 7, 2012     Carlos M. Rivera-Serrano, MD; Brian J. Park, MD, MPH; Robert L. Ferris, MD
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Abstract

Thyroid hematoma secondary to blunt trauma is uncommon, and no consensus exists for its management. We describe the case of a 46-year-old man who presented with neck swelling after he had sustained a blunt-trauma injury to his neck while playing soccer. Imaging revealed a large mass consistent with a thyroid hematoma. The patient was admitted for observation and followed up with serial imaging. He was eventually discharged without surgical intervention. However, he later underwent a thyroid lobectomy to treat compressive symptoms and for cosmetic reasons. Pathology revealed that the patient had a papillary thyroid carcinoma, which might have predisposed him to the hemorrhage. Thyroid hematoma secondary to blunt trauma has been documented in normal thyroid glands and in glands with preexisting benign pathology, but to the best of our knowledge, no report associating this condition with a thyroid carcinoma has previously been reported in the literature. A neoplasm should be suspected in a case of thyroid hematoma that fails to resolve with conservative treatment. The management of this condition is surgeon- and case-specific, and the overall prognosis is good.

Salivary duct carcinoma

September 7, 2012     Lester D.R. Thompson, MD
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Atypical presentation of mucoepidermoid carcinoma after radiation therapy for the treatment of keloids

July 5, 2012     James K. Fortson, MD, MPH; Michael Rosenthal, DMD; Vijaykumar Patel, MBBS, FRCS; Gillian E. Lawrence, MD; Jennifer S. Lin, MD
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Abstract

Radiation therapy to the head and neck for the treatment of benign diseases carries the potential for the late development of carcinoma. Low-dose radiation has been used as an adjunctive treatment for recurrent keloids, especially massive keloids, but the carcinogenic potential of ionizing radiation in this setting remains controversial. We report the case of a 37-year-old black woman with a history of severe earlobe keloids who had been first treated with resection and postoperative radiation at the age of 9 years. When she had reached the age of 36 years, she required reoperation for massive keloid scarring, after which she underwent a second course of postoperative radiation to the right side of her face and neck. Some 20 months after the second administration of radiation therapy, she developed a mucoepidermoid carcinoma in the right parotid gland. The tumor was successfully treated with surgery.

Papillary carcinoma in a lingual thyroid: An unusual presentation

July 5, 2012     Kiran M. Bhojwani, MS; Mahesh Chandra Hegde, MS; Arathi Alva, MS; K.V. Vishwas, MBBS, MS
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Abstract

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.

Adenoid cystic carcinoma of the nasal cavity: A case report

June 4, 2012     Angel J. Perez, MD, LT MC USN; Parul Goyal, MD
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Abstract

Adenoid cystic carcinoma (ACC) is the most common malignant tumor of the minor salivary glands. The sinonasal tract is a common site of ACC occurrence, second only to the oral cavity. Of all cases of sinonasal ACC, a minority (22 to 35%) arise in the nasal cavity. Three histologic patterns of ACC have been described: cribriform, tubular, and solid. Compared with the cribriform and tubular forms, predominantly solid-type ACCs have been associated with higher rates of perineural invasion, higher S-phase fractions, and a higher incidence of aneuploidy. The histologic differentiation of solid-pattern ACC from other sinonasal malignancies typically requires the identification of one or both of the other ACC patterns in the same specimen. We present the case of a 39-year-old man with solid-pattern ACC arising in the nasal cavity. The tumor was resected endoscopically. We also discuss the relevant literature regarding the histologic diagnosis, prognosis, and treatment options for solid-pattern ACC.

Distant cutaneous metastasis from oropharyngeal squamous cell carcinoma

June 4, 2012     Mridula Shukla, DipNB; Vinay Kumar, MS; Manoj Pandey, MS
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Abstract

Squamous cell carcinoma is the most common malignant neoplasm of the upper aerodigestive tract. The disease is characterized by frequent lymphatic spread; however, blood-borne distant metastasis is rare. Isolated cutaneous metastasis is even rarer. We present two cases of oropharyngeal carcinoma that presented with cutaneous metastasis in the absence of disease recurrence. Both patients were treated with wide excision of the metastatic nodule and were disease-free at the 1.5-year follow-up. This article highlights the importance of cutaneous metastasectomy.

Poorly differentiated small-cell neuroendocrine carcinoma of the submandibular gland: A case report

March 31, 2012     Mary Scaduto, MD, Laura Matrka, MD, Manisha Shah, MD, Paul Wakely Jr., MD, and Enver Ozer, MD
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Abstract

Neuroendocrine carcinoma (NEC) is uncommon in the head and neck and rare in the salivary glands. In the latter location, it may manifest as pain or a palpable mass. These tumors can be quite aggressive, with a tendency toward recurrence and regional and distant metastasis. Because of the limited number of reported cases in the literature, no reliable treatment has been established. We describe the case of a 79-year-old man who presented with a persistent submandibular mass that was suspicious for a malignancy on imaging. Following surgical resection and histopathologic analysis, a diagnosis of poorly differentiated small-cell NEC was made. The patient was further treated with postoperative chemotherapy, and he exhibited no evidence of recurrence or metastasis on follow-up.

Neuroendocrine carcinoma of the head and neck: A 20-year case series

March 1, 2012     Ryan Meacham, MD, Laura Matrka, MD, Enver Ozer, MD, H. Gulcin Ozer, PhD, Paul Wakely, MD, and Manisha Shah, MD
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Abstract

Neuroendocrine carcinoma (NEC) can be an aggressive disease with locoregional and distant metastasis. We present this article (1) to highlight the typical presentation of NEC in head and neck primary sites such as the parotid gland, paranasal sinuses, and supraglottis and (2) to discuss the prognosis of these tumors based on their histologic subtype and stage. We base our comments on the findings of our retrospective review of the cases of 16 adults-10 men and 6 women, aged 43 to 88 years (mean: 65.8)-who had been diagnosed with pathologically confirmed NEC of the head and neck. Analysis of subtypes revealed that 11 of these patients (68.8%) had presented with poorly differentiated NEC, 4 (25.0%) with moderately differentiated NEC, and 1 (6.3%) with well-differentiated NEC. The most common primary sites were the salivary glands (n = 5; 31.3%), paranasal sinuses (n = 4, 25.0%), and larynx (n = 4). There was no statistically significant difference in survival at 24 months between the patients with moderately differentiated NEC and those with poorly differentiated NEC (37.5 vs. 35.4%; p = 0.86); at the end of the study period, the patient with well-differentiated NEC was still living, 129 months after diagnosis. Taken together, patients with stage I, II, and III disease had a combined survival of 77.8% at 12 months, which was significantly higher (p = 0.023) than the 57.1% survival at 12 months for patients with stage IV disease.

Atypical carcinoid (moderately differentiated neuroendocrine carcinoma) of the uvula

February 18, 2012     Nelson C. Goldman, MD and Robert E. Barnes Jr., MD
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Abstract

Carcinoid (neuroendocrine) tumors of the head and neck rarely occur outside the larynx and, until now, none has been reported in the oral cavity. We describe what we believe is the first reported case of an atypical carcinoid tumor, or any other type of neuroendocrine carcinoma, of the uvula.

Unusual parapharyngeal acinic cell carcinoma

February 18, 2012     Jeremy Nguyen, MD, Enrique Palacios, MD; FACR, Elorice Horam, MD, and Harold Neitzschman, MD, FACR
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Hepatocellular carcinoma presenting as an isolated sphenoid sinus lesion: A case report

January 25, 2012     Shantanu Tandon, MS, DNB, Arun Nair, DNB, DLO, MBA, Anisha Sawkar, DNB, DMRD, A.M. Balasubramanya, MS, and Diganta Hazarika, MD
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Abstract

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.

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