Cases reported "Head and Neck Neoplasms"

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1/75. Primary melanocytic schwannoma of cervical sympathetic chain.

    BACKGROUND: Primary melanocytic schwannoma arising from the cervical sympathetic chain is a rare pigmented nerve sheath tumor. Two cases are presented from an academic medical center. patients and methods patients were initially seen with an enlarging neck mass associated with sympathetic nervous system dysfunction. radiography demonstrated a mass located posterior to the carotid sheath. Primary therapy consisted of surgical excision and postoperative radiation therapy. RESULTS: The tumors were found to be melanocytic schwannomas arising from the cervical sympathetic chain. The pathologic characteristics of this neoplasm are reviewed. One patient remained disease free for 12 years after treatment, whereas 1 patient died as a result of local recurrence and distant metastases. CONCLUSIONS: Melanocytic schwannoma of the cervical sympathetic chain is a rare nerve sheath tumor of the head and neck that may be misdiagnosed as malignant melanoma. The clinical behavior of this neoplasm is variable. Preoperative neurologic findings, anatomic location, electron microscopy, and immunohistochemistry findings help to establish the diagnosis, and electron microscopy may have a role in distinguishing between benign and malignant lesions. Complete surgical excision is the treatment of choice.
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ranking = 1
keywords = melanoma, malignant melanoma
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2/75. perfusion therapy for skin cancer.

    Surgical techniques for the selective administration of anti-cancer drugs is presented. These isolated-perfusion or intra-arterial infusion procedures have achieved significant palliation for many patients with advanced cancer. When used in conjunction with surgical excision of certain early skin cancers, such as aggressive forms of malignant melanoma of the extremities, improved cure rates may be achieved.
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ranking = 1
keywords = melanoma, malignant melanoma
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3/75. Complete spontaneous regression of Merkel cell carcinoma: a review of the 10 reported cases.

    BACKGROUND: Merkel cell (neuroendocrine) carcinoma (MCC) is a very aggressive primary cutaneous neoplasm occurring most often on the head and neck of the elderly. Complete spontaneous regression (CSR) of MCC was first described in 1986. Since then other cases have been reported bringing the total to 10. OBJECTIVE: To review these 10 cases and obtain long-term follow-up data, to compare them for similarities and differences. METHOD: Each original case report was extensively reviewed and authors contacted in most cases for confirmation and updated information. RESULTS: In no case did MCC recur after CSR was noted, although follow-up information in some cases was short. When CSR occurred, it was swift and dramatic with complete regression of skin and lymph node metastasis in 1-3 months. CONCLUSION: While only 10 cases of CSR is a small number, MCC is itself a rare malignancy with just over 600 reported cases. Today most cases of MCC receive aggressive combined therapy effectively precluding diagnosis of CSR. The nature of regression in these 10 cases may point toward future immunologic therapy just as similar cases of CRS in patients with melanoma have led to advances in the immunologic treatment for that malignancy.
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ranking = 0.62152898499749
keywords = melanoma
(Clic here for more details about this article)

4/75. Metastatic melanoma of the heart.

    BACKGROUND: Malignant melanoma has an unpredictable biologic behavior and is the neoplasm with the greatest propensity for cardiac involvement. Although relatively frequent at autopsy, cardiac metastases are rarely identified antemortem. methods: We reviewed 2,810 patients with histologically confirmed malignant melanoma, who were diagnosed and followed up by our clinic. Clinical, histological, and imaging data are presented. RESULTS: Five cases of metastatic melanoma of the heart were identified out of 314 melanoma patients with visceral involvement. One case of a 53-year-old woman, who died unexpectedly during her first chemotherapy course, is described in detail. Postmortem examination determined the cause of death to be the presence of multiple melanoma metastases in the heart, even though the patient had shown no signs of cardiac involvement. CONCLUSIONS: The unpredictable biologic behavior of melanoma may lead to unusual metastatic sites, and, therefore, the heart also should be included in routine examinations.
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ranking = 6.5937608649774
keywords = melanoma, malignant melanoma
(Clic here for more details about this article)

5/75. magnetic resonance imaging appearance of metastatic Merkel cell carcinoma to the sacrum and epidural space.

    Merkel cell carcinoma (MCC) is a rare malignant tumor of the skin and often is diagnosed histologically as lymphoma, melanoma and even metastatic small cell carcinoma of the lung (SCCL). Classified as a neuroendocrine tumor, clinically it originates in the head and neck region and may present with metastatic disease at the time of presentation [1]. Osseous involvement in the past has been described to involve regional facial bones only. We present the first reported MRI findings of distant osseous metastasis from a Merkel cell carcinoma to the lumbosacral spine with associated soft tissue and epidural involvement. Appropriate treatment and patient survival depend on prompt diagnostic imaging for establishment of metastatic disease. Previous reports have advocated CT for diagnosis and staging of distant metastases [2,3]. When spinal involvement is suspected, MRI may be a more suitable modality for assessment of the epidural space and appropriate staging and follow-up in such cases.
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ranking = 0.62152898499749
keywords = melanoma
(Clic here for more details about this article)

6/75. Ultraviolet-assisted punch biopsy mapping for lentigo maligna melanoma.

    lentigo maligna melanoma (LMM) accounts for a substantial incidence of all locally recurrent melanoma. In addition, the head and neck area accounts for 60% to 90% of all LMMs, which has important functional and cosmetic implications. The difficulty in the identification of the true borders of LMM may account for the high incidence of local recurrence. The purpose of this study was to evaluate the efficacy of ultraviolet-assisted punch biopsy mapping to identify clear margins using identified, 2-mm circumferentially arranged punch biopsies at the junction of the pigmented and nonpigmented borders. A retrospective chart review of 20 patients with biopsy-confirmed LMM of the head and neck was performed. Using ultraviolet identification, 2-mm circumferentially arranged biopsy specimens were obtained and sent for formal pathological review, including immunohistochemical staining. The average time for completion of pathological review was 5 to 7 days. If the punch biopsies were positive for lentigo maligna or LMM, punch biopsies were obtained more peripherally. Once clear, margins were obtained and definitive resection was performed. Twenty patients with biopsy-proved LMM were evaluated. Follow-up ranged from 6 months to 3 years (mean follow-up, 1 year). Fourteen patients were cleared after their first series of biopsies, 3 patients required a second series of biopsies, 2 patients required a third session, and 1 patient required a fourth biopsy session. To date, there has been no evidence of recurrence. No patients required reexcision for positive surgical margins. One complication has been local cellulitis of a punch biopsy site requiring a short course of antibiotics. Ultraviolet-assisted punch biopsy mapping of LMM is a safe, well-tolerated, and accurate technique for identifying the true histological margin of LMM. The procedure reduces the need for repeat surgical excisions to obtain clear margins and may decrease the risk for recurrence by mapping accurately the true histological margin.
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ranking = 3.7291739099849
keywords = melanoma
(Clic here for more details about this article)

7/75. Malignant melanoma with a myxoid stroma: a diagnostic pitfall on fine-needle aspiration biopsy.

    Malignant melanoma (MM), both primary and metastatic, may be associated with a prominent myxoid stromal reaction causing diagnostic confusion on fine-needle aspiration biopsy (FNAB), most often with sarcomas that demonstrate a myxoid stroma, particularly malignant peripheral nerve sheath tumor (MPNST). We present a case of a 32-yr-old man with no past medical history who presented with a unilateral neck mass clinically suspicious for lymphoma. FNAB produced a specimen composed of large sheets of anaplastic cells encased in a myxoid stroma that was S100 and vimentin-positive but HMB-45-negative. A diagnosis of MPNST was made. Excision demonstrated a metastatic MM of unknown primary, with a prominent myxoid stromal reaction. A repeat HMB-45 was again negative. Electron microscopy demonstrated intracytoplasmic melanasomes and cisternae of rough endoplasmic reticulum with intracisternal parallel tubules, confirming the diagnosis. Although HMB-45 is typically negative in both tumors, S100 should be strongly positive in myxoid MM and only focal in MPNST.
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ranking = 3.1076449249875
keywords = melanoma
(Clic here for more details about this article)

8/75. Mucosal malignant melanomas of the head and neck with special reference to cases having a prolonged clinical course.

    A histological re-examination and re-classification of primary mucosal tumours of the head and neck region, treated at Radiumhemmet and Karolinska Sjukhuset during the period 1927-1970, revealed that 41 tumours were malignant melanomas. All these 41 tumours were located in the nasal cavity, paranasal sinuses and oral cavity and not a single case of primary mucosal malignant melanoma was found in other locations of the head and neck region. In the present study, the long-term prognosis has been analysed. The follow-up period was at least 5 years and ranged up to 48 years. It was found that mucosal malignant melanomas had a very poor prognosis with a five year survival rate of 17% (7 of the total 41 cases) and a ten year survival rate of 7% (3 of the total of 41 cases). The unpredictability of the clinical behaviour of this tumour type is elucidated by cases with a prolonged clinical course despite a primary relatively limited surgery, repeated local recurrences and regional lymph node metastases in an early stage of the disease. Thus, there is always a never-ceasing risk of death in the tumour disease when once a malignant melanoma has occurred. For this reason a meticulous and lifelong follow-up of tumour patients is stressed, and also the value of repeated surgery of local recurrences and regional lymph node metastases.
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ranking = 8
keywords = melanoma, malignant melanoma
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9/75. Congenital Spitz nevus clinically mimicking melanoma.

    The differentiation between atypical variants of Spitz nevus and melanoma is often difficult given the many clinical and histopathologic similarities between the two. We report a case of an infant with a congenital scalp lesion exhibiting clinical features of melanoma, including variegation and regression of pigmentation and a rapidly changing appearance. Histologic examination of the excised lesion revealed a benign congenital Spitz nevus. This case emphasizes the need for clinical and histologic correlation in determining the benign or malignant nature of atypical pigmented lesions in infants.
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ranking = 3.7291739099849
keywords = melanoma
(Clic here for more details about this article)

10/75. Desmoplastic neurotropic melanoma of the head and neck: the role of radiation therapy.

    BACKGROUND: Desmoplastic neurotropic melanoma (DNM) is an uncommon cutaneous melanoma variant with pronounced neurotropism. In contrast to ordinary melanomas, locoregional recurrences are common and distant metastasis are uncommon in patients with DNM. Local control with surgery and radiation therapy may assume a more important role in this variant of melanoma. We present a case of an unresectable skull base recurrence of DNM that was controlled using radiation therapy alone and review the literature. methods: Case report with 36-month follow-up. RESULTS: The patient is a 68-year-old with multiple recurrences of a DNM that originated on the forehead. After extensive surgery, including total parotidectomy and temporal bone resection, the patient had an unresectable recurrence of the skull base develop. This was treated with definitive radiation therapy, resulting in a complete response. The patient has had no evidence of recurrence at 3 years. CONCLUSIONS: DNM is a locally aggressive type of melanoma with a high risk of local recurrence that can be radioresponsive. The incidence of distant metastasis is low, so aggressive treatment to control local disease is warranted. This may include surgery plus adjuvant radiation therapy or definitive radiotherapy for unresectable recurrences.
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ranking = 5.5937608649774
keywords = melanoma
(Clic here for more details about this article)
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