Carcinoma

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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Unusual parapharyngeal acinic cell carcinoma

January 25, 2012     Jeremy Nguyen, MD, Enrique Palacios, MD, FACR, Elorice Horam, MD, and Harold Neitzschman, MD, FACR
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Squamous cell carcinoma of the middle ear

January 25, 2012     Min-Tsan Shu, MD, Jehn-Chuan Lee, MD, Cheng-Chien Yang, MD, and Kang-Chao Wu, MD
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Disfiguring basal cell carcinoma of the nose (“clown nose”)

January 25, 2012     Jose Aneiros-Fernandez, MD, Salvador Arias-Santiago, MD, Cesar Garcia-Lopez, MD, and Francisco O'Valle, MD, PhD
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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.

Thyroid carcinoma with intravascular metastasis to the internal jugular vein

December 15, 2011     Ryan F. Osborne, MD, Hootan Zandifar, MD, and Reena Gupta, MD
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