June 11, 2013 Jason M. Samuelian, DO; Brandon J. Fisher, DO; Larry C. Daugherty, MD; and Usha A. Babaria, MD
article
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.
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
article
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.
July 5, 2012 Pradipta Kumar Parida, MBBS, MS; Jaimanti Bakshi, MBBS, MS; Sanjeev Bhagat, MBBS, MS; Ramandeep Singh Virk, MBBS, MS
article
Abstract
Leiomyosarcoma is usually found in the female genital tract, the retroperitoneum, the wall of the gastrointestinal tract, and subcutaneous tissues. An appearance of this malignant tumor in the parapharyngeal space is extremely rare and may be difficult to diagnose. Because of its rarity, little information exists on management and prognosis. We report the case of a 50-year-old man with a parapharyngeal space leiomyosarcoma who was treated with total excision of the tumor and postoperative radiotherapy. At follow-up 6 months postoperatively, he was well and free of disease. To the best of our knowledge, this is only the third case of a leiomyosarcoma in the parapharyngeal area to be reported in the literature. We discuss the diagnosis and treatment of leiomyosarcoma in this aspect.
June 4, 2012 Mridula Shukla, DipNB; Vinay Kumar, MS; Manoj Pandey, MS
article
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.
October 26, 2011 Joseph Chun-Kit Chung, MRCS and Wai-Kuen Ho, FRCS
October 26, 2011 Brian Thomas, MD, Candice Black, DO, Tate Maddox, MD, and Giridhar Venkatraman, MD
article
Abstract
We present an exceedingly rare case of chondromyxoid fibroma of the nasal cavity and palate. This rare tumor usually occurs in the metaphyses of the long bones. Our patient's tumor was diagnosed by biopsy, and it was resected en bloc. At the 2-year follow-up, the patient was doing well with no signs of recurrence. We review the pathologic characteristics, differential diagnosis, and treatment of chondromyxoid fibroma of the nasal cavity.
April 30, 2011 Christopher R. Grindle, MD, Joseph M. Curry, MD, Joshua P. Cantor, MD, Kelly M. Malloy, MD, Edmund A. Pribitkin, MD, and William M. Keane, MD
article
Abstract
An otherwise healthy 29-year-old woman presented with a complaint of odynophagia of several months' duration. On examination, she was found to have a broadly based, yellow, exophytic lesion on the right lateral pharyngeal wall. Findings on biopsy were consistent with amyloidosis. The patient underwent tonsillectomy with resection of the oropharyngeal lesion. Final pathology established a diagnosis of nodular non-AL-type amyloidosis. Localized amyloidosis of the oropharynx is exceptionally rare. Additionally, most cases of localized amyloidosis are of the AL type, not the AA (i.e., non-AL) type seen in this patient.
December 17, 2010 Sowmya T. Rajaram, MD, Flora D. Lobo, MD, and Chandrayya Achary, MD
article
Abstract
Oropharyngeal lymphomas are rare, typically high-grade neoplasms. We describe a case of plasmablastic lymphoma that originated in the oropharynx of a 40-year-old man who was positive for human immunodeficiency virus (HIV). The diagnosis was based on fine-needle aspiration cytology of the mass followed by histopathologic examination supplemented with immunophenotyping. The mass was excised, but the patient refused antiretroviral therapy, and he died within 6 months of the diagnosis. In HIV-positive patients, non-Hodgkin lymphomas frequently involve sites, including the oropharynx, that are unusual in patients without HIV.
October 31, 2010 Daniel P. Nadeau, MD, LCDR, MC, USN, Paul C. Shick, CAPT, DC, USN, and Robin Lindsay, MD, LCDR, MC, USN
article
Abstract
Adenosquamous carcinoma of the head and neck is a rare and aggressive tumor, with fewer than 100 cases reported in the world literature to date. We report a case of adenosquamous carcinoma of the oral pharynx arising as a second primary malignancy in a patient being treated for primary gastric MALT (mucosa-associated lymphoid tissue) lymphoma. We also review the literature to assess current treatment and long-term prognosis of this rare tumor.
October 31, 2009 Akhtar Hussain, FRCS and Andrew Evans, MRCS, DLO
article
Abstract
Defects in the structure of the oropharynx can result in significant functional deficit and lead to nasal regurgitation and rhinolalia aperta. Many techniques have been described to reconstruct surgical oropharyngeal defects that are created during resection of squamous cell carcinoma, including the use of local advancement flaps and free-tissue transfers. We describe our experience with using a myomucosal uvular transposition flap for oropharyngeal reconstruction in a series of 11 patients. Unlike flap techniques that involve the use of palatal or uvular tissue, our technique does not require release incisions in the contralateral palate. This simple technique can be used to reconstruct defects as large as 50% of the soft palate and lateral oropharynx with minimal postoperative morbidity and only a minimal increase in surgical time compared with free-tissue transfer and myocutaneous pedicled flaps.
April 30, 2009 Eleftheria Kiverniti, MRCSEd, DO-HNS, Ulkem Cilasun, DDS, PhD, Arvind Singh, BSc, MRCS, DLO, Rehan Kazi, MS, Peter M. Clarke, BSc, FRCS, and Daniel J. Archer, FDSRCS, FRCS
article
Abstract
We present the case of a 23-year-old woman with aggressive fibromatosis of the oropharynx that was initially treated elsewhere as a peritonsillar abscess. We discuss the characteristics of this rare tumor and review the literature, stressing the importance of postoperative follow-up for peritonsillar abscesses to avoid missing other important diagnoses, such as the one described here.
July 31, 2007 Samer Rajjoub, BA; Suzanne R. Basha, MD; Eugene Einhorn, MD; Marc C. Cohen, MD; Doug M. Marvel, BA; Duane A. Sewell, MD
article
Abstract
The presence of tumor-infiltrating lymphocytes has been shown to significantly improve clinical outcomes in many types of cancer. However, their effects on outcomes in patients with oropharyngeal cancer specifically have yet to be elucidated. We conducted a retrospective study in an effort to shed light on this issue. We reviewed the records of 48 consecutively presenting patients with oropharyngeal cancer, and we performed immunohistochemistry to analyze their archived paraffin-embedded tissue samples for the presence of CD3-positive tumor-infiltrating lymphocytes. We also used real-time polymerase chain reaction testing to look for human papillomavirus type 16 (HPV-16) in the tumors. We found that patients with large numbers of tumor-infiltrating lymphocytes (CD3high) had a significantly lower incidence of metastasis at presentation than did those with low numbers of tumor-infiltrating lymphocytes (CD3low) (40.0 vs. 88.5%; p = 0.001), regardless of HPV status. When HPV status was taken into account, the correlation between a high CD3 count and a lower rate of metastasis was maintained in the HPV-positive patients but not in the HPV-negative patients. We also found that the CD3high patients had higher rates of overall survival and disease-free survival at 3 and 5 years than did the CD3low patients; however, these differences only approached but did not reach statistical significance.
