Cases reported "Head and Neck Neoplasms"

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1/313. Axillary nodal metastases in head and neck cancer.

    BACKGROUND: Axillary node metastasis is an uncommon occurrence in squamous carcinoma of the upper aerodigestive tract. methods: The tumor registry of The Johns Hopkins University Department of otolaryngology-Head and Neck Surgery contained four cases of metastasis to the axilla from head and neck primary sites. A retrospective review of these cases was performed. RESULTS: Each patient had been initially treated for cancer years earlier including surgery and radiation to the neck. A recurrent cancer or a new primary then developed in the upper aerodigestive tract prior to the development of the axillary metastases. CONCLUSIONS: The common course of disease in these patients suggests that alteration of the lymphatic anatomy by previous treatment may have caused a new pattern of metastatic spread upon reseeding from the mucosa, resulting in the axillary metastases. Routine surveillance of the axillae by physical examination and/or computerized imaging in at risk patients may permit the early diagnosis of axillary metastases.
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keywords = radiation
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2/313. Intensity-modulated radiotherapy: first results with this new technology on neoplasms of the head and neck.

    Intensity-modulated beam radiotherapy (IMRT) delivers a highly conformal, three-dimensional (3-D) distribution of radiation doses that is not possible with conventional methods. When administered to patients with head and neck tumors, IMRT allows for the treatment of multiple targets with different doses, while simultaneously minimizing radiation to uninvolved critical structures such as the parotid glands, optic chiasm, and mandible. With 3-D computerized dose optimization, IMRT is a vast improvement over the customary trial-and-error method of treatment planning. We retrospectively reviewed the charts of the first 28 head and neck patients at our institution who were treated with IMRT. All had head and neck neoplasms, including squamous cell carcinoma, adenoid cystic carcinoma, paraganglioma, and angiofibroma. Total radiation doses ranged from 1,400 to 7,100 cGy, and daily doses ranged from 150 to 400 cGy/day. A quality assurance system ensured that computer-generated dosimetry matched film dosimetry in all cases. For midline tumors, this system allowed us to decrease the dose to the parotid glands to less than 3,000 cGy. The incidence of acute toxicity was drastically lower than that seen with conventional radiotherapy delivery to similar sites. This is the first report of the application of IMRT strictly to head and neck neoplasms. We discuss the indications, technique, and initial results of this promising new technology. We also introduce the concept of the Simultaneous Modulated Accelerated radiation Therapy boost technique, which has several advantages over other altered fractionation schemes.
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keywords = radiation
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3/313. Percutaneous dilatational tracheostomy in a patient with thyroid cancer and severe airway obstruction.

    A patient with extensive metastatic thyroid cancer scheduled for palliative tracheostomy is presented. He had laryngeal dislocation with severe airway obstruction and few anatomical landmarks due to tumour infiltration and radiation. Successful percutaneous dilatational tracheostomy was performed under local anaesthesia.
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4/313. Histologic transformation of polymorphous low-grade adenocarcinoma of salivary gland.

    Polymorphous low-grade adenocarcinoma of salivary gland origin (PLGA) was initially described in 1984 and has since become an established clinicopathologic entity. Owing to the indolent nature of PLGA and its relatively recent description, the full clinicopathologic spectrum of this entity has not been elucidated fully. Transformation to a histologically different-appearing lesion or progression to a higher histologic grade has not been reported. We describe 2 PLGAs arising in the palate and associated with multiple locoregional recurrences that were treated with excision and radiation therapy. This was followed by histologic transformation to a higher grade neoplasm after 17 and 26 years, respectively. The histologic appearance after transformation was characterized by a predominantly solid and cystic growth pattern, nuclear atypia with prominent nucleoli, and foci of necrosis. High-grade transformation of PLGA may occur after a protracted clinical course with multiple recurrences of typical PLGA. The possible role of radiation therapy as an initiator of this transformation merits further study. Tumors with these histologic features should not be included under the rubric of typical PLGA. Segregation of these neoplasms will allow further study of their biologic potential, particularly with regard to possible increased rates of local recurrence and metastasis.
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ranking = 2
keywords = radiation
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5/313. Technical management of a pregnant patient undergoing radiation therapy to the head and neck.

    The fetal dose in a pregnant patient undergoing radiation therapy to the head and neck region was investigated. Implicit in this study was the design and evaluation of a shield used to minimize the fetal dose. To evaluate the fetal dose, a phantom was irradiated with the fields designed for this patient's therapy. The peripheral dose was measured for each field individually, both without and with a custom shield designed to be placed about the patient's abdominal and pelvic regions. The total dose at the location of the fetus over the course of this patient's radiation therapy was then estimated from peripheral dose rate measurements made at several points within the simulated uterus. With no shielding, the total dose within the uterus of the patient would have ranged from 13.3 cGy at the cervix to 28 cGy at the fundus. With the shield applied, the uterine dose was significantly less: 3.3 cGy at the cervix to 8.6 cGy at the fundus. In fact, at every measurement point, the peripheral dose with the shield in place was 30% to 50% of the dose without the shield. Some data suggest that the rate of significant abnormalities induced by irradiation in utero increases with increasing dose within the range of total peripheral doses incurred during most radiation treatment courses. It is therefore prudent to make reasonable attempts at minimizing the dose to the lower abdominal and pelvic regions of any pregnant patient. The shield designed in this work accomplished this goal for this patient and is flexible enough to be used in the treatment of almost all tumor volumes.
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ranking = 8
keywords = radiation
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6/313. The role of positron emission tomography in occult primary head and neck cancers.

    PURPOSE: To evaluate the utility of positron emission tomography (PET) fluorodeoxyglucose (FDG) imaging in the workup of unknown primary head and neck tumors. methods: Fourteen patients with squamous cell carcinoma of cervical lymph node metastasis of unknown primary origin (clinical stage N2-N3) were studied prospectively. The patients underwent conventional workup, including physical examination, computed tomography, and random biopsies of the potentially suspected sites. If no primary site was found, 8 to 13 mCi of FDG was given intravenously, and whole-body scans with standardized uptake values were obtained. The results of FDG-PET imaging were compared with clinical, CT, and histopathologic findings. To eliminate bias, PET scans were reviewed by nuclear medicine physicians who had no previous knowledge of the other findings. RESULTS: PET identified the location of primary tumor in three patients: lung hilum, base of tongue, and pyriform sinus. These lesions were pathologically confirmed. All these primary sites were not visualized on CT or physical examination, except for a pyriform sinus lesion, which was seen on CT, but initial biopsy result was negative. In one patient, the initial PET did not identify a primary tumor, but a nasopharyngeal carcinoma was identified in post-radiation therapy follow-up PET. In the remaining nine patients, a primary lesion was never found. All cervical lymph nodes detected by CT were identified by PET. DISCUSSION: A previously unknown primary tumor can be identified with FDG-PET in about 21% of the patients in our prospective series. PET can be of value in guiding endoscopic biopsies for histologic diagnosis and treatment options.
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keywords = radiation
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7/313. Malignant triton tumor of the head and neck: A case report and review of the literature.

    BACKGROUND: Malignant triton tumor (MTT) is a relatively rare, aggressive tumor comprised of both malignant schwannoma cells and malignant rhabdomyoblasts. Because MTT frequently arises in the head and neck, the otolaryngologist must be aware of the nature of the tumor and its response to various treatment modalities. METHOD: This article reviews the treatment and outcome of all reported cases of MTT arising in the head and neck. CONCLUSIONS: Although statistical analysis is limited by the short duration of follow-up of many patients, complete tumor resection appears to carry an improved chance of survival. Adjuvant radiation and chemotherapy may also improve survival, although a benefit of these therapies was not well demonstrated in this small series.
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ranking = 1
keywords = radiation
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8/313. Primary cutaneous adenoid cystic carcinoma metastatic to cervical lymph nodes.

    BACKGROUND: Adenoid cystic carcinoma (ACC) occurs not only as a neoplasm of salivary glands but also in the skin. Metastasis is rare, and metastasis to lymph nodes has not been reported in the English literature. Case Report A patient with a history of excisions of "cylindroma" of the scalp over the past 20 years was initially seen with 2 recurrent scalp nodules and a firm left neck mass. Both scalp lesions and multiple neck nodes were found to be ACC at resection. The patient underwent postoperative radiation therapy and is clinically free of disease at 4 years. CONCLUSIONS: We believe this represents the first reported case of nodal metastases from primary cutaneous ACC in the English literature.
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ranking = 1
keywords = radiation
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9/313. osteoradionecrosis of the hyoid bone: a report of 3 cases.

    PURPOSE: osteonecrosis of the hyoid bone is an uncommon disease that has only been described occasionally in the literature. MATERIALS AND methods: We report 3 cases of osteonecrosis of the hyoid bone after radiation therapy for carcinoma at various sites in the head and neck region. RESULTS: Imaging computed tomography (CT) scans were performed for all 3 cases and did aid in the diagnosis. In 1 case, a 201thallium scintigraphy and a bone scan (99mtechnetium-diphosphonate) were performed and this confirmed the diagnosis of osteoradionecrosis. CONCLUSION: osteoradionecrosis of the hyoid bone may be misdiagnosed as recurrent neoplasm. Although recurrent or persistent neoplastic disease must initially be ruled out, it is subsequently important to correctly identify osteonecrosis of the hyoid bone, because its surgical treatment is simple and the prognosis is good.
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keywords = radiation
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10/313. 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.
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ranking = 3
keywords = radiation
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