Carcinoma

Mucoepidermoid carcinoma presenting as a large cyst of the parotid gland in HIV disease

July 21, 2013     Nelson Goldman, MD; Sania Shuja, MD; Raafat Makary, MD; Reginald L. Griffin, MD
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Abstract

Cystic lesions of the parotid gland may be the presenting symptom in human immunodeficiency virus (HIV)-positive patients. The most common lesion is the benign lymphoepithelial cyst. Malignant lesions may also be associated with-or be hidden by-a cystic mass. We report a case of mucoepidermoid carcinoma in a 40-year-old HIV-positive woman who presented with a large cystic mass of the parotid that had been previously misdiagnosed as benign on several fine-needle aspiration biopsies. On our histologic examination, the true pathologic nature of the lesion was revealed. We suggest that an image-guided fine-needle aspiration biopsy of the thickened wall of cystic masses of the parotid may be more diagnostic than a random sampling of the contents.

Wrong egg in the usual nest: Thyroid papillary carcinoma within a branchial cleft cyst

July 21, 2013     Mustafa Sagit, MD; Ayhan Gokler, MD; Istemihan Akin, MD; Unsal Han, MD
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Abstract

Branchial cleft cysts are the most common lesions to arise laterally in the neck. Ectopic thyroid tissue within a branchial cleft cyst is rare, and a papillary carcinoma arising from this tissue is extremely rare. We present a case of a lateral neck cyst representing a primary papillary carcinoma that arose in ectopic thyroid tissue within a branchial cleft cyst in a 41-year-old woman. After the mass was surgically excised, thyroid ultrasonography, thyroid scintigraphy, and whole-body F18-fluorodeoxyglucose-positron emission tomography/computed tomography detected no abnormality. The negative findings notwithstanding, surgery on the thyroid gland was planned, but the patient refused it. Therefore, she was followed up with ultrasonography and scintigraphy for 5 years, during which time she exhibited no evidence of recurrence. Total thyroidectomy is still the primary option in such cases, but when it cannot be performed for any reason, vigilant follow-up is essential.

Metastatic choriocarcinoma: A rare presentation as a neck mass

June 11, 2013     Hilmi Alper Senkal, MD; Taner Yilmaz, MD; and Ahmet Bulent Sozeri, MD
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Abstract

Testicular carcinoma metastatic to the neck is rare. Even more rare is a finding of choriocarcinoma as a neck mass without any sign of a primary testicular tumor, as only a few cases have been reported in the literature. We describe a new case that occurred in a 29-year-old man who presented with a neck mass. Fine-needle aspiration biopsy identified the tumor as a malignant epithelial neoplasm. Radiologic findings indicated the presence of a systemic metastasis of a tumor to the chest and abdomen, as well as the neck. Findings on an incisional biopsy of the neck mass were consistent with a choriocarcinoma. The testicles were normal on palpation and ultrasonography. The patient was diagnosed with metastatic choriocarcinoma with an unknown primary, and he was started on chemotherapy. On the second day of treatment, which was 25 days after his referral to our clinic, he died of respiratory insufficiency.

Oropharyngeal squamous cell carcinoma metastatic to lower-extremity soft tissues: A case report and literature review

June 11, 2013     Jason M. Samuelian, DO; Brandon J. Fisher, DO; Larry C. Daugherty, MD; and Usha A. Babaria, MD
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Abstract

A 52-year old man was referred to our service for evaluation after being diagnosed with oropharyngeal squamous cell carcinoma. Contrast-enhanced computed tomography (CT) revealed a mass in the left tonsillar pillar, as well as submental lymphadenopathy. The extent of tumor infiltration was assessed by fluoro-2-deoxyglucose positron emission tomography scans, which showed increased uptake in the tumor bed and a suspicious-looking lymph node near the right hilum. No other signs or symptoms of distant metastasis were evident at that time, and the patient was treated with induction chemotherapy followed by chemoradiation. Several weeks after treatment completion, the patient returned, complaining of right medial foot edema. CT of the right lower extremity revealed multiple high-attenuation masses in the soft tissues of the right leg and foot, including a mass in the medial plantar region of the foot. Approximately 15 to 20% of patients with oropharyngeal squamous cell carcinoma develop distant metastasis throughout the course of the disease. Soft-tissue metastases from oropharyngeal cancers are rare, however, particularly when they present in the absence of widespread metastasis. A review of the current head and neck tumor literature describes soft-tissue metastases in less than 10% of patients with known distant metastases. Metastasis to distal regions such as the lower extremities has rarely been observed but should be included in the differential diagnosis for patients presenting with lower-extremity pain or edema.

Case report: Metastatic breast cancer presenting as a hypopharyngeal mass

March 24, 2013     Rodrigo Bayon, MD; Sandra K. Banas, MD; Barry L. Wenig, MD, MPH
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Abstract

Although carcinoma of the breast has a propensity toward distant metastasis, metastasis to the head and neck is uncommon. Most patients with metastasis to the head and neck region present with cervical lymphadenopathy; however, spread to the upper aerodigestive tract has been described previously. We present a case of a patient found to have a pedunculated mass in her right piriform sinus. When she swallowed, the mass would completely prolapse into the esophagus and cause symptoms. Subsequent workup revealed widespread metastatic disease, for which the patient was treated with chemoradiotherapy. Microlaryngoscopy with excision of the mass was performed for palliation of her dysphagia, and a diagnosis of metastatic breast carcinoma was obtained. The patient healed well from the excision and went on to be treated for the metastatic breast cancer. To our knowledge, our report represents the first case of metastatic breast carcinoma presenting as severe dysphagia.

Metastatic hepatocellular carcinoma in the nasal vestibule

March 24, 2013     Jinsu Choi, MD; Bosung Kim, MD
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Extrahepatic metastasis is a major independent predictor of a poor prognosis in patients with HCC.

Middle ear metastasis from dormant breast cancer as the initial sign of disseminated disease 20 years after quadrantectomy

March 24, 2013     Teresa Pusiol, MD; Ilaria Franceschetti, MD; Francesca Bonfioli, MD; Francesco Barberini, MD; Giovanni Battista Scalera, MD; Irene Piscioli, MD
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Abstract

We describe an unusual case of breast cancer metastatic to the middle ear in a 71-year-old woman. The metastasis was the initial sign of disseminated disease 20 years after the patient had undergone a quadrantectomy for her primary disease. Computed tomography (CT) demonstrated the presence of an intratympanic mass with a soft-tissue density that was suggestive of chronic inflammation. The patient underwent a canal-wall-down tympanoplasty. When a brownish mass was found around the ossicles, a mastoidectomy with posterior tympanotomy was carried out. However, exposure of the tumor was insufficient, and therefore the posterior wall of the ear canal had to be removed en bloc. Some tumor was left on the round window membrane so that we would not leave the patient with a total hearing loss. Our case highlights the limitations of CT and magnetic resonance imaging in differentiating inflammatory and neoplastic lesions.

Transoral surgery alone for human-papillomavirus-associated oropharyngeal squamous cell carcinoma

February 25, 2013     Steven M. Olsen, MD; Eric J. Moore, MD; Rebecca R. Laborde, PhD; Joaquin J. Garcia, MD; Jeffrey R. Janus, MD; Daniel L. Price, MD; Kerry D. Olsen, MD
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Abstract

The aim of this retrospective study was to describe the oncologic and functional results of treating oropharyngeal squamous cell carcinoma with transoral robotic surgery and neck dissection as monotherapy. A review was performed, including all patients who underwent transoral robotic surgery and neck dissection as the only means of therapy for oropharyngeal carcinoma from March 2007 to July 2009 at a single tertiary care academic medical center. We reviewed all cases with ≥24-month follow-up. Functional outcomes included tracheostomy dependence and oral feeding ability. Oncologic outcomes were stratified by human papillomavirus (HPV) status and tobacco use and included local, regional, and distant disease control, as well as disease-specific and recurrence-free survival. Eighteen patients met study criteria. Ten patients (55.6%) were able to eat orally in the immediate postoperative period, and 8 (44.4%) required a temporary nasogastric tube for a mean duration of 13.6 days (range 3 to 24 days) before returning to an oral diet. No patient required placement of a gastrostomy tube, and all patients are tracheostomy-tube-free. Among the HPV-positive nonsmokers (12/18, 66.7%), Kaplan-Meier estimated 3-year local, regional, and distant control rates were 90.9%, 100%, and 100%, respectively. Kaplan-Meier estimated disease-specific survival and recurrence-free survival were 100% and 90.9%, respectively. No complications occurred.

This study suggests that carefully selected patients with HPV-positive oropharyngeal carcinoma can be effectively treated with surgery alone with excellent functional and oncologic outcomes.

Hepatocellular carcinoma metastatic to the mandible

February 25, 2013     Mia E. Miller, MD; Andrew A. McCall, MD; Guy F. Juillard, MD; Celina M. Nadelman, MD; Marilene B. Wang, MD; Vishad Nabili, MD
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Abstract

We describe the case of a 55-year-old man with known multifocal hepatocellular carcinoma (HCC) who presented with a painful mandibular mass. Fine-needle aspiration cytology of the mass revealed the presence of bile canaliculi and bile formation, an extremely rare finding. Findings on immunoperoxidase staining of the aspirate were consistent with an HCC. Since the patient was known to have multiorgan metastatic disease, he was administered palliative radiation therapy to the mandibular metastasis for pain control, which was achieved. One year after presentation, the patient died as a result of disease progression. HCC rarely metastasizes to the mandible, as only about 70 such cases have been reported in the literature. We discuss the histopathologic appearance of HCC metastatic to the mandible, the radiologic findings, and the established treatment modalities.

Primary papillary carcinoma of the thyroid arising in a branchial cyst: Case report and review of the literature

February 25, 2013     Parvathidevi K. Gollahalli, SSAHE; Panduranga Chikkannaiah, MD, SSAHE; Vamseedhar Annam, MD, SSAHE
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Abstract

We report a case of papillary carcinoma of the thyroid that arose in a branchial cyst. The patient, a 45-year-old woman, presented with a left lateral neck mass of 3 months' duration. The cyst was removed intact. Because we could not rule out the possibility that a small primary malignancy was present within the gland, we performed a total thyroidectomy; however, no occult primary tumor of the thyroid was found. The patient was placed on thyroid hormone replacement therapy, and she was well at 2 years of follow-up. We briefly review the literature regarding the possible embryologic origin of such a phenomenon and the role of fine-needle aspiration cytology in differentiating a branchial cyst from a metastatic lymph node. To the best of our knowledge, this is only the 11th reported case of a thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst, and the second such report from India.

Mucoepidermoid carcinoma of the larynx with transglottic involvement in a child: A case report

December 31, 2012     Sanjeev Bhagat, MS; Saurabh Varshney, MS; Rakesh K. Singh, MS; Sampan Bist, MS
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Abstract

Mucoepidermoid carcinoma (MEC) of the larynx is one of the rarest tumors in the pediatric age group. Our review of the English-language literature found only 1 previously reported case of a laryngeal MEC in a child. We present what to the best of our knowledge is the first case of a pediatric MEC of the larynx with transglottic involvement. Our patient was a 12-year-old girl who presented with long-standing hoarseness and recent dysphagia, breathing difficulty, and pain radiating to the left ear. Investigation revealed the presence of an endophytic mass in the larynx. Histopathologic examination of biopsy tissue identified the mass as a low-grade MEC. The patient was scheduled to undergo a total laryngectomy 1 week later, but she did not report for surgery. Three weeks later, she presented to the emergency department in a semiconscious state and in respiratory distress. Despite all resuscitative measures, she died.

Nasopharyngeal metastasis of follicular carcinoma of the thyroid with extensive clear cell change: A case report

December 31, 2012     Trupti Shreyans Patel, MD; Swapan L. Desai, MD; Priti P. Trivedi, MD; Manoj J. Shah, MD
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Abstract

Thyroid carcinoma metastatic to the maxillofacial area is extremely rare. Other carcinomas can metastasize to this area, but very few cases of follicular thyroid carcinoma metastasizing to the nasopharynx have been reported. Carcinoma from the kidney, liver, large bowel, prostate, and thyroid are known to have the potential for clear cell differentiation, and all of them can metastasize to the sinonasal area. Histochemical and immunohistochemical evaluations, along with clinical details, are useful in distinguishing metastases of these clear cell tumors from primary sinonasal tumors. In this article we describe a rare case of metastatic thyroid carcinoma with clear cell change mimicking metastatic renal cell carcinoma in the nasopharynx.

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