1/84. osteoradionecrosis of the cervical vertebrae and occipital bone: a case report and brief review of the literature.osteoradionecrosis (ORN) is a common complication of radiation therapy. We present the first case reported in the literature of ORN involving the first and second cervical vertebrae and occipital bone in a patient who was treated with surgery and radiation therapy 9 years prior for a TxN3M0 squamous cell carcinoma of the left neck arising from an unknown primary origin. A brief review of the pathophysiology and treatment of this pathological process is also presented. Although the mandible is the most commonly affected site in the head and neck, ORN may develop in an unusual location without any preceding trauma and display an insidious but rapidly progressive course. The pathophysiology of ORN is believed to be a complex metabolic and homeostatic deficiency created by radiation-induced cellular injury and fibrosis, which is characterized by the formation of hypoxic, hypovascular, and hypocellular tissue. The irradiated bone loses its capability to increase the metabolic requirements and nutrient supply required to replace normal collagen and cellular components lost through routine wear. This results in tissue breakdown and the formation of a chronic nonhealing wound. infection plays only a contaminant role, with trauma being a possible initiating factor. diagnosis of ORN begins with a complete physical examination, including fiberoptic examination and biopsy of any suspicious lesion to eliminate the possibility of recurrent tumor. Treatment of ORN commonly requires the debridement of necrotic bone and hyperbaric oxygen therapy. The head and neck surgeon must possess a high degree of suspicion to promptly diagnose ORN and initiate early treatment. Because of similarities in clinical presentation, the most important step in the initial management of suspected ORN is to eliminate the possibility of tumor recurrence or a new primary.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
2/84. Diagnostic challenges in the fine-needle aspiration diagnosis of carotid body paragangliomas: report of two cases.Two cases of carotid body paragangliomas sampled by fine-needle aspiration (FNA) cytology prior to other medical diagnostic studies are presented. In the first case, the presence of an ipsilateral ulcerative lesion of the nasopharynx along with pronounced atypia of the specimen posed a challenge to the correct cytologic interpretation, which was initially sidetracked in favor of a metastatic epithelial lesion. In the second case, a tumor mass of unusually large size and extension which included the pharynx, coupled with a large amount of profusely hemorrhagic aspirate, presented a diagnostic problem, which was overcome by processing part of the specimen as a cell block, which by its histologic and immunochemical features provided a definitive pathologic diagnosis. In handling these two clinically complex cases of carotid paraganglioma, two learning principles became clear on how to reach a correct FNA diagnosis in such lesions: 1) The anatomic location of the lateral neck mass with its prolonged history, along with a hemorrhagic FNA specimen exhibiting at least some cytologic features reminiscent of endocrine neoplasm, are among the factors that help in arriving at a suggestive diagnosis of paraganglioma, when other clinical features tend to sidetrack from interpretation of the cytologic changes. 2) In the practice of FNA cytology, if the possibility of paraganglioma arises, processing part of the specimen as a cell block with accompanying histology and immunohistochemistry can provide a definitive diagnosis of such lesion.- - - - - - - - - - ranking = 2keywords = process (Clic here for more details about this article) |
3/84. Difficult problems and their solutions in patients with cancer pain of the head and neck areas.pain management can be especially difficult in patients with head and neck cancer due to the erosive nature of the neoplasms that invade the region, the rich innervation of the head and neck, and other factors. Consequently, diagnosis is a complex process that cannot be dealt with in a cursory fashion. Furthermore, tumor pain can mimic noncancer conditions, nonmalignant orofacial disorders can be suggestive of tumor growth, and antineoplastic treatment-related conditions can be difficult to distinguish from tumor recurrence. A series of case reports illustrates key elements of diagnosis and pain management in patients with head and neck cancer. These elements include 1) detailed assessment of pain intensity and characteristics; 2) appropriate use of analgesic adjuvant medications; 3) use of diagnostic and therapeutic nerve blocks and myofascial trigger point injections; and 4) a high index of suspicion regarding tumor recurrence pain.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
4/84. Marjolin's ulcer presenting in the neck.'Marjolin's ulcer' is a term that has come to be used for epidermal squamous cell carcinomas that have developed in areas of chronic inflammation. To our knowledge this is the first ever report of a Marjolin's ulcer developing following long-term irritation of the skin of the neck. The history of the eponym is traced and reveals that Marjolin probably never actually described this pathological process.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
5/84. Marjolin's ulcer of the scalp: report of 5 cases and review of the literature.The formation of neoplastic changes in the scar tissue of chronically ulcerating wounds is a well-known process. This condition is most commonly seen after the postburn scars, but it may be seen after many kinds of scars. The term "Marjolin's ulcer" is used to describe this type of carcinoma. Although many different cell types can be seen in these lesions, the most commonly seen is squamous cell carcinoma. Squamous cell carcinomas resulting from the Marjolin's ulcer have a much greater tendency to metastasize than squamous cell carcinomas resulting from the other causes. confusion continues about the precise pathophysiology of this lesion and the clinical behavior of this neoplasm, and the mortality and morbidity rates are also conflicting. As would be expected, there is a wide variety of suggested treatment protocols for this disease. This article, through case reports and review of the literature, offers criteria for the treatment of the Marjolin's ulcers that arise on the scalp, which is an uncommon site.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
6/84. plasma cell variant of Castleman's disease occurring concurrently with Hodgkin's disease in the neck.BACKGROUND: Castleman's disease, a benign lymphoproliferative disorder, may be seen as a self-limited, curable unifocal process, or highly aggressive multicentric disease frequently resulting in death despite aggressive management. Non-Hodgkin's lymphoma has been known to arise within the context of Castleman's disease, usually when multicentric. Hodgkin's lymphoma, however, can also arise within the context of Castleman's disease, but this is a rare process. We report a case of unifocal Castleman's disease (plasma cell variant) occurring concurrently with Hodgkin's disease in the neck of a young woman. methods: The presentation, workup, pathologic evaluation, and management of a young woman diagnosed with Castleman's disease occurring concurrently with Hodgkin's disease in the neck is presented and discussed. RESULTS: A 32-year-old woman with a 5-year history of unifocal right cervicoparotid Castleman's disease (plasma cell variant) underwent right functional neck dissection and superficial parotidectomy for cosmetic and functional purposes. Pathologic and immunohistochemical analysis confirmed Hodgkin's lymphoma occurring in a background of the plasma cell variant of Castleman's disease. The patient subsequently underwent external beam radiation therapy as definitive management for her early-stage Hodgkin's lymphoma. CONCLUSIONS: Castleman's disease can occur as an isolated regional process in the head and neck. Furthermore, lymphoma (and specifically Hodgkin's lymphoma) can develop within regionally isolated cervical Castleman's disease. Although complete surgical excision of unifocal Castleman's disease is curative, the management of lymphoma occurring within the context of the Castleman's disease warrants a standard lymphoma workup and management strategy.- - - - - - - - - - ranking = 3keywords = process (Clic here for more details about this article) |
7/84. The lateral transfacetal retrovascular approach for an anteriorly located chordoma originating from the second cervical vertebra.BACKGROUND: Anteriorly located lesions at the craniocervical junction (CCJ) require careful surgical planning to avoid neuraxis retraction. Several different routes have been described in the search for the most appropriate yet least invasive approach. However, most of these far-lateral posterior approaches are specifically tailored for non-osseous intradural tumours or chordomas with cephalad extension. We introduce an approach that allows for better access to laterally extending osseous tumours originating from the second cervical vertebra. Using this approach, the lesion is manipulated from a strictly lateral direction parallel to a plane through the articular pillar of the CCJ and the odontoid process, and the C1- and C2-laminae are spared for posterior fixation. METHOD: The application of this approach is demonstrated in detail by an illustrative case of a chordoma originating from C2 that presented with intradural mass effect, considerable bone destruction, far-lateral extension to the right, and vertebral artery involvement. FINDINGS: The described approach gave ample access for total tumour resection. It allowed for safe control and displacement of the vertebral artery, spinal cord decompression, C2-corpectomy across the midline, and anterolateral bone reconstruction. No C1- or C2-hemilaminectomy was needed, and these bone elements could be used for posterior fixation (the patient presented in this study was referred to our institution after posterior fixation from the occiput to C3 had already been performed elsewhere). No intra-operative or postoperative complications occurred. At the 6-month follow-up, the patient was fully ambulatory with no neurological deficit. INTERPRETATION: The described lateral transfacetal route is the method of choice for operating on laterally extending osseous tumours originating from the second cervical vertebra.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
8/84. Superficial leiomyosarcoma of the head and neck: case report and review of the literature.Superficial leiomyosarcomas are rare in the head and neck region. Because of the infrequent nature of soft tissue sarcomas in general, superficial leiomyosarcomas are often misdiagnosed on clinical grounds. immunohistochemistry is essential for an accurate histologic diagnosis, and it should include a broad panel of antibody studies. With respect to differences in clinical appearance and biologic behavior, superficial leiomyosarcomas can be broadly classified as either cutaneous or subcutaneous; local control and overall survival are significantly more favorable in patients with the former. The primary treatment of a leiomyosarcoma is a wide surgical excision with an emphasis on negative margins. Treatment failures are usually attributable to a local recurrence. Systemic metastasis occurs in about one-third of patients with subcutaneous involvement. Although cutaneous leiomyosarcoma is considered a relatively more benign process with minimal metastatic potential, systemic metastasis is still possible. This was demonstrated in our case, as a recurrent cutaneous leiomyosarcoma metastasized to the lung. Proper management requires inclusion of this entity in the differential diagnosis, as well as familiarity with its clinical behavior. In this article, we review the literature on superficial leiomyosarcoma and discuss its epidemiology, presentation, clinical behavior, evaluation, tissue diagnosis, staging, and treatment.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
9/84. Fine needle aspiration biopsy of pediatric head and neck masses.OBJECTIVE: To determine if fine needle aspiration (FNA) can preclude the requirement for diagnostic open biopsy in suspicious pediatric head and neck masses. methods: The records of 40 children presenting to an inner city tertiary care hospital who underwent a total of 50 FNA biopsies during the years 1988-1999 were reviewed. From these 40 patients, 17 children, aged 3 months to 18 years, underwent both clinically indicated FNA biopsy and subsequent open surgical biopsy or excision. Outcome measurements included clinical resolution or surgical pathologic diagnosis. RESULTS: The 17 patients who underwent open surgical biopsy subsequent to the FNA had a total of 21 FNAs performed. Three of these patients had more than one needle biopsy prior to surgery. The histologic diagnosis of the surgical excision confirmed the FNA biopsy cytologic diagnosis in all but two cases. FNA cytologic diagnostic categories included reactive lymph node/non-specific inflammation (25 biopsies), benign cystic process (four), granulomatous disease (eight), malignant neoplasm (three), and benign neoplasm (one). Eight of nine FNAs initially non-diagnostic had either complete resolution of the mass or a diagnosis obtained by subsequent FNA or open biopsy. CONCLUSIONS: FNA is a valuable diagnostic tool in the management of children with the clinical presentation of a suspicious neck mass. The technique reduces the need for more invasive and costly procedures. Early surgical biopsy, however, should be considered in rapidly enlarging masses, in the presence of persistent systemic symptoms, and when repeated FNA cytology is non-diagnostic.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
10/84. Fine-needle aspiration biopsy.OBJECTIVES: Fine-needle aspiration biopsy (FNAB) is a technique in which a fine needle is introduced into a mass, cellular material is aspirated, and a cytological diagnosis is rendered. It separates reactive and inflammatory processes that do not require surgical intervention from neoplasia and benign from malignant tumors. FNAB lends itself to the diagnosis of palpable head and neck masses, in particular, those that persist following antibiotic treatment. STUDY DESIGN/methods: This clinical state-of-the-art review article is intended to provide an overview of the clinical use of FNAB in the management of head and neck masses. Relevant case histories are used to illustrate this point. RESULTS: Fine-needle aspiration biopsy has a high overall diagnostic accuracy of 95% for all head and neck masses, 95% for benign lesions, and 87% for malignant ones. CONCLUSIONS: There are virtually no contraindications, and complications are minimal. Advantages of FNAB are that it is safe and simple, it can be performed as an outpatient procedure, and it is well tolerated by patients. In the present managed care environment, it also proves cost-effective. The diagnosis is readily known to the clinician, and appropriate treatment modalities can be discussed with the patient. It is recommended as a first line of investigation in palpable head and neck masses.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
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