1/77. Epithelial-myoepithelial carcinoma arising in the nasal cavity: a case report and review of literature.Epithelial-myoepithelial carcinoma is an uncommon, low-grade, malignant epithelial neoplasm composed of variable proportions of ductular cells and large, clear staining, myoepithelial cells arranged around the periphery of the ducts. About 120 cases have been reported in the world literature, most of which were located in salivary glands, except for a few cases occurring in unusual locations such as breast, lacrimal gland, nose, paranasal sinus, trachea, bronchus, and lung. We here reported the second case of epithelial-myoepithelial carcinoma of the nasal cavity with extension to the nasopharynx. The patient was a 61 year old Chinese female with two month's history of progressive nasal obstruction. Histopathologically, the tumor showed typical myoepithelial and ductal cells biphasic differentiation, duct-like structure and infiltrating growth pattern. Some ductal cells showed the characteristics of oxyphilic cell, which had never been reported before. recurrence and metastasis rates of epithelial-myoepithelial carcinoma varied from 35% to 50% and 8.1% to 25% respectively in different reports. The present case had neither recurrence nor metastasis twenty months after operation. When epithelial-myoepithelial carcinoma is mainly composed of spindle myoepithelial cells, the differential diagnosis should include myoepithelioma, neurofibroma, leiomyoma and hemangiopericytoma.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/77. A patient with undifferentiated carcinoma of gallbladder presenting with hemobilia.hemobilia is relatively rare among hemorrhages in the digestive tract, and hemobilia caused by tumors of the biliary tract is particularly rare. We treated a 74-year-old-man with undifferentiated carcinoma of the gallbladder presenting with hemobilia. During hospitalization for neurogenic bladder at the Department of urology, he showed progressive anemia. Since hemorrhage in the digestive tract was suspected, endoscopy of the upper gastrointestinal tract was performed, and bleeding from the papilla of Vater was observed. On ultrasound examination, findings were indicative of cholecystic cancer, and hemorrhage from the cystic duct was found on percutaneous transhepatic cholangioscopy. On perioral cholecystoscopy, however, masses of coagulated blood were found only in the gallbladder. Abnormalities such as dense staining of tumors or extravasation were not found on angiography. The patient died of hepatic failure due to rapid invasion of the liver by the tumor, associated with biliary infection and disseminated intravascular coagulation. At autopsy, a nodal tumor was found in the gallbladder, and the cavity of the gallbladder was filled with coagulated masses of blood. Direct invasion of the tumor to the liver, diaphragm, and transverse colon was found. The histopathological diagnosis was undifferentiated carcinoma (pleomorphic large-cell type).- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
3/77. recurrence of giant adrenocortical carcinoma in the contralateral adrenal gland 6 years after surgery: report of a case.We report herein the case of a patient in whom a giant adrenocortical carcinoma was found to have recurred in the contralateral adrenal gland and intrapelvic cavity 6 years after his initial operation. A 52-year-old man had consulted our hospital complaining of right upper abdominal pain and weight loss, and was subsequently diagnosed as having a giant adrenal tumor by computed tomography scans and echography. A laparotomy was performed and the tumor, located in the right retroperitoneal cavity and infiltrating the liver and right kidney, was surgically removed. The lesion, 29 x 19 x 10 cm in size and 4700 g in weight, was histopathologically diagnosed as an adrenocortical carcinoma. Adjuvant chemotherapy with mitotane was given for 3 months and his postoperative course was uneventful until a recurrence in the contralateral adrenal gland and peritoneal cavity was found 6 years later. The second resection was successful, and he is currently alive with no further sign of recurrence 8 years after his first operation. We report this unusual case as it provides much useful information on the biological features of adrenocortical carcinomas and the state of tumor dormancy.- - - - - - - - - - ranking = 0.6keywords = cavity (Clic here for more details about this article) |
4/77. brain abscess formation in radiation necrosis of the temporal lobe following radiation therapy for nasopharyngeal carcinoma.BACKGROUND: radiation necrosis is a known complication following radiation therapy for extracranial as well as intracranial tumours. However, brain abscess formation in radiation necrosis has not been reported in the literature. We report the clinical data of 6 patients suffering from this condition. METHOD: Twenty-eight patients with radiation necrosis of the temporal lobe following radiotherapy for nasopharyngeal carcinoma were treated surgically at the Department of neurosurgery, Queen Elizabeth Hospital, hong kong between January 1992 and July 1999. Of these, 6 cases were complicated by brain abscess formation. The clinical data of these 6 patients are retrospectively reviewed. FINDINGS: The patients were 5 males and 1 female, ranging in age from 41 to 67 years. Three patients had previous treatment with steroids for the symptomatic radiation necrosis. A history of nasal infection or otitis media was recognised in all 6 patients. All patients were treated surgically by temporal lobectomy and excision of the necrotic tissue together with the abscess cavity. Intra-operatively, a bony defect was observed between the middle cranial fossa and the sphenoid sinus in 3 patients and the bony defect was repaired with a temporalis muscle flap. The species of organisms could only be identified in 3 patients. In 3 patients, the pus smear was positive but the culture was negative. Subsequently, 4 patients recovered and 2 patients died. INTERPRETATION: Cerebral radiation necrosis is a predisposing cause of brain abscess formation. Surgical excision is recommended as the treatment of choice in this group of patients.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
5/77. protein c deficiency in microvascular head and neck reconstruction.OBJECTIVE: To determine the incidence of perioperative protein c deficiency in patients undergoing free flap reconstruction of cancer-related defects in the head and neck. STUDY DESIGN: Prospective case series. INTERVENTION: Ten patients underwent microvascular reconstruction after surgical therapy of carcinomas of the oral cavity or oropharynx. Coagulation studies were determined in all patients 72 hours after surgery. SETTING: Academic tertiary care medical center RESULTS: protein c deficiency was detected in 70% of patients. One free flap failure was attributed to protein c deficiency. CONCLUSIONS: vitamin k-dependent clotting factors are frequently deficient during the postoperative period after major head and neck surgery, which may result in a state of hypercoagulability. protein c deficiency should be considered as a possible cause of free flap thrombosis in patients who undergo microvascular head and neck reconstruction.- - - - - - - - - - ranking = 1.0534234509204keywords = oral cavity, cavity (Clic here for more details about this article) |
6/77. Sinonasal undifferentiated carcinoma: case series and review of the literature.OBJECTIVE AND IMPORTANCE: We report on four cases of sinonasal undifferentiated carcinoma (SNUC), a relatively newly described clinicopathological entity of the nasal cavity and paranasal sinuses. SNUC tends to present with advanced-stage disease, often with intracranial invasion, and requires an aggressive treatment approach that includes surgical resection. A review of the literature identified several reports of SNUC in pathology and otolaryngology journals since its initial description in 1986, but no report has yet appeared in the neurosurgery literature. CLINICAL PRESENTATION: Four patients presented with various symptoms related to the nose and/or orbit, including one or more of the following: obstruction, epistaxis, decreased visual acuity, diplopia, and pain. All patients were noted to have masses in the nasal cavity or paranasal sinuses, with or without intracranial extension. INTERVENTION: All four patients underwent multimodal treatment with chemotherapy, radiotherapy (60-65 Gy), and aggressive surgical resection via a combined bifrontal craniotomy and a subcranial approach to the anterior cranial fossa. Three of four patients died as a result of their disease, an average of 15 months after diagnosis. Only one patient remains alive, although with metastatic intracranial disease, at 24 months after diagnosis. CONCLUSION: SNUC is a rare neoplasm with a poor prognosis despite an aggressive multimodal approach to treatment. On the basis of our experience, we advocate radical resection as part of the initial combined therapy for patients who present with locally advanced, nonmetastatic disease but we suggest reserving surgery for patients with early brain invasion until there has been a radiographically proven central nervous system response to adjuvant therapy.- - - - - - - - - - ranking = 0.4keywords = cavity (Clic here for more details about this article) |
7/77. Epithelial-myoepithelial carcinoma of the nasal cavity.A 22-year-old male presented with a 1-year history of nasal obstruction due to a polypoid mass in the right nasal cavity. Histopathologic examination revealed the tumor to consist of a mixture of a trabecular structure with a double-layered arrangement of inner dark cells and outer clear cells. Immunohistochemical examination showed the clear cells to be positive for alpha-smooth muscle actin and S-100 protein. Ultrastructural examination confirmed the myoepithelial cell origin. The tumor was excised and no recurrence or metastasis was found 40 months after surgery. We describe here a rare case of epithelial-myoepithelial carcinoma arising from the nasal cavity, one of the most unusual locations.- - - - - - - - - - ranking = 1.2keywords = cavity (Clic here for more details about this article) |
8/77. adult respiratory distress syndrome occurring in two patients undergoing cytoreductive surgery plus perioperative intraperitoneal chemotherapy: case reports and a review of the literature.Cytoreductive surgery and perioperative intraperitoneal chemotherapy with mitomycin C and 5-fluorouracil may be considered as an accepted treatment for appendiceal malignancy with mucinous peritoneal carcinomatosis or for pseudomyxoma peritonei. This aggressive approach has been successfully utilized in approximately 500 patients with an acceptable mortality (1.5%) and morbidity (27%). Although pulmonary complications are frequently recorded, life-endangering acute respiratory failure in the absence of pulmonary infection or an obvious source of systemic sepsis has not been previously described. An extensive clinical review of two patients who had a clinical course compatible with acute respiratory distress syndrome without obvious cause except for the cytoreductive surgery and perioperative intraperitoneal chemotherapy itself was undertaken. These two patients developed gradually increasing respiratory distress in the postoperative period. No bacterial or fungal infections of lungs or intra-abdominal sites or sepsis were discovered. These two patients were unusual in that they had extensive cytoreduction, maximal heat with the mitomycin C chemotherapy, and perfusion of both the abdominal cavity and the right pleural space. reoperation in both patients failed to show a septic source within the abdomen for progressive adult respiratory distress syndrome. We conclude that aggressive cytoreductive surgery plus perioperative intraperitoneal and intrapleural chemotherapy was associated with life-endangering respiratory failure in two patients. No other cause for this condition was evident from an exhaustive review of the clinical course of these two patients. It is possible that this aggressive approach to appendix malignancy with carcinomatosis is sufficiently traumatic to be considered a cause of adult respiratory distress syndrome.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
9/77. Extensive F-18 FDG uptake in metastatic spindle cell carcinoma of the lung.A 77-year-old man with stage IIB squamous cell carcinoma of the lung underwent right upper lobectomy. One month later he was examined for right chest pain, dyspnea, cough, and weakness. A roentgenogram showed nondiagnostic diffuse opacification of his right lung cavity. An F-18 FDG positron emission tomographic (PET) study revealed extensive uptake in the right pleural area, left adrenal gland, right axilla, and soft tissues consistent with extensive local recurrence and metastatic disease. biopsy of a right chest soft tissue lesion showed spindle cell carcinoma, a rare variant of squamous cell carcinoma.- - - - - - - - - - ranking = 0.2keywords = cavity (Clic here for more details about this article) |
10/77. Multiple primary tumors. Four distinct head and neck tumors.The case history of a 70-year-old woman with the simultaneous occurrence of mucoepidermoid carcinoma of the parotid gland, thyroid carcinoma, squamous cell carcinoma of the oral cavity, and a Warthin tumor is described. The simultaneous occurrence of three histologically distinct malignant tumors is a rare event amounting to approximately 1% of cases of multiple primary tumors. This case is unusual in that the tumors occurred in three separate organs and in association with a papillary cystadenoma lymphomatosum. While difficult to evaluate, prognosis and treatment should be approached with respect to each of the tumors as individual entities.- - - - - - - - - - ranking = 1.0534234509204keywords = oral cavity, cavity (Clic here for more details about this article) |
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