Carcinoma

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.

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.

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.

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.

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.

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.

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