Cases reported "Lymphatic Metastasis"

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11/333. Distant lymphatic metastasis from head and neck cancer.

    A predictable pattern of metastasis based on tumor histology and site of origin has been well documented for most cancers that arise in the head and neck region. The current study demonstrates that this predictable pattern of metastasis can be significantly impacted by previous therapy, resulting in unusual patterns of metastasis in patients with recurrent tumors. A retrospective case series of 5 patients with head and neck carcinomas who developed metastases to distant lymph nodes is presented. All patients underwent surgery and radiotherapy to the primary tumor and regional lymphatics at the time of their initial treatment. All of the patients developed a local recurrence less than a year before the detection of distant lymphatic metastases. Cytology or excision confirmed metastases to the axillary, inguinal, or anterior intercostal lymph nodes. All of the patients underwent aggressive surgery for attempted cure of the local recurrence shortly before the presence of distant lymphatic metastases was clinically recognized. The metastatic workup of patients with carcinomas of the head and neck frequently includes examination of the regional lymph nodes as well as chest radiography, liver function tests, and serum calcium determination. This evaluation may fail to detect metastases to distant lymph nodes in patients who present with recurrent or second primary cancers. Such patients should undergo careful examination of all major lymph node-bearing regions of the body when being evaluated for the presence of distant metastases.
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12/333. Malignant ectopic thymoma in the neck: a case report.

    We report a case of malignant ectopic thymoma in the neck. Contrast-enhanced CT of the neck showed a well-defined inhomogeneously enhancing mass in the left jugulodigastric chain. One year after surgery, the mass had metastasized to the tongue base, and CT of the neck showed an ill-defined densely enhancing mass with lymphadenopathy.
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13/333. Supradiaphragmatic manifestations of papillary serous adenocarcinoma of the ovary.

    AIM: To illustrate unusual patterns of isolated supradiaphragmatic presentation and relapse of papillary serous adenocarcinoma of the ovary. methods: Retrospective study of five women (26-57 years) managed by a specialist gynaecological oncology unit. RESULTS: Three women relapsed in the neck, mediastinal or axillary nodes 3 to 5 years after complete abdomino-pelvic remission. Two women presented with pleural or cervical lymph node metastases respectively 2 and 13 years before the primary pelvic tumour was discovered. Clinical presentations in these five women mimicked metastatic thyroid and breast cancer and mesothelioma. In four of the five woman supradiaphragmatic nodal disease was heavily calcified. CONCLUSION: women with papillary serous ovarian cancer may develop supradiaphragmatic disease without evidence of peritoneal metastasis or primary pelvic tumours. Isolated supradiaphragmatic relapse may occur many years after complete remission of abdomino-pelvic disease. Calcification in supradiaphragmatic lymph nodes should not be assumed to be due to old granulomatous disease as this may be the only clue to relapsing disease. review of prior histology and use of immunohistochemical stains were valuable in diagnosis of these cases.
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14/333. 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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15/333. lymphoscintigraphy, sentinel lymph node biopsy, and Mohs micrographic surgery in the treatment of Merkel cell carcinoma.

    BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high incidence of occult nodal metastases. MCC is believed to be similar in natural history to thick or ulcerated melanomas in its propensity for locoregional recurrence and early lymph node metastasis. Studies have shown that nodal status is statistically correlated to survival in MCC. Radiolocalization and superselective lymph node biopsy is a recent technique that has been proven to be of great value in evaluating the status of occult lymph node disease in malignant melanoma and breast cancer patients. OBJECTIVE: In previously untreated patients, an orderly progression of metastases is observed for both cutaneous carcinomas and malignant melanomas and is anticipated for MCC. methods/RESULTS. We present two patients with MCC of the head and neck who underwent simultaneous Mohs micrographic surgery and sentinel lymph node biopsy with intraoperative radiolocalization. CONCLUSION: sentinel lymph node biopsy and intraoperative lymphoscintigraphy may prove to be a useful technique in evaluating occult nodal involvement and in limiting the potentially unnecessary morbidity of more comprehensive lymph node dissections in MCC patients who do not yet have metastatic involvement.
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16/333. paraganglioma as a systemic syndrome: pitfalls and strategies.

    Tumours of the neuroendocrine system in the head and neck region are mostly paragangliomas of the glomus tympanicum or jugulare, or of the carotid body. The majority of these tumours are benign, and the coexistence of multiple paragangliomas seems to be rare. Pre-operative embolization and surgery are regarded as primary therapy for these tumours. The treatment regimen in any patient depends on age, general health, hearing status and the function of the lower cranial nerves. Several presentations are possible in which paragangliomas occur as systemic disease. 1. Paragangliomas may occur bilaterally, or, in rare cases, in multiple areas. Pre-operative bilateral angiography is of utmost importance. In case of multicentricity, it might be necessary to proceed without, or just with, unilateral surgery for preservation of adjacent structures. In surgery of jugular vein paraganglioma, we usually perform a modified transmastoidal and transcervical approach with preservation of middle-ear structures and the ossicles. As an alternative or supplement to surgery, radiotherapy or definitive embolization may be used in the treatment of paragangliomas. 2. Paragangliomas may occur as multiple endocrine neoplasia (MEN) syndrome combined with medullary thyroid gland carcinoma, and, facultatively, pheochromocytoma. In these cases, endocrinological examination and magnetic resonance imaging (MRI) of the adrenal region, the thorax and the neck are required for an adequate therapeutic strategy. As MEN may be inherited, family history should be evaluated. 3. Paragangliomas can became malignant and metastasize. Thus, cervical lymph node metastases or distant metastases may occur. We recommend the removal of all ipsilateral lymph nodes and their histological examination.
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17/333. Cytologic diagnosis of metastatic basal cell carcinoma. Report of a case with immunocytochemical and molecular pathologic considerations.

    BACKGROUND: Metastases of basal cell carcinoma (BCC) are extraordinarily rare events, with only about 200 published reports. The usefulness of immunohistochemical markers in the diagnosis of metastatic BCC was previously established on cytologic material. Furthermore, in recent years, numerous molecular markers have been studied to explain its pathogenesis and relatively indolent behavior. CASE REPORT: A 62-year-old, white male presented with lymphadenopathy in the right side of the neck. The patient had a long-standing history of multiple excisions of BCCs during the previous 30 years. Fine needle aspiration biopsy revealed tight clusters and sheets of small, round tumor cells with hyperchromatic nuclei, small nucleoli and minimal cytoplasm. In addition, in some of the clusters the tumor cells showed peripheral palisading. Based on the cytomorphology and diffuse immunohistochemical positivity for a low-molecular-weight cytokeratin marker, MNF 116, and negativity for AE1/AE3, Cam5.2, synaptophysin and chromogranin, a diagnosis of metastatic BCC was rendered. Subsequent histopathologic examination of metastatically involved lymph nodes removed in a radical neck dissection confirmed this diagnosis. In addition, on histologic sections the metastatic tumor cells were found to express bcl-2 and CD44, markers that have been recently studied in cutaneous tumors. CONCLUSION: In acquiring metastatic potential, this lesion did not lose the molecular characteristics of bcl-2 and CD44 expression, the two features deemed to be important in the indolent behavior of BCC.
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18/333. Papillary renal cell carcinoma presenting as nodal metastases to the neck.

    Renal cell carcinoma, in a high percentage of patients, metastasizes early, sometimes mimicking other lesions. We present a case of an asymptomatic papillary renal cell carcinoma that presented neck metastases as the initial manifestation. The laterocervical and supraclavicular masses were considered consistent with nodal metastases from a thyroid nodule. A hemithyroidectomy was performed before the renal tumor was diagnosed. Then the patient underwent a left-side radical nefrectomy. We discuss the unpredictability of the clinical course of renal cell carcinoma.
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19/333. Three cases of malignant lymphoma of the breast.

    We report three cases of malignant lymphoma (ML) of the breast and discuss diagnosis and management. The first case is a 35-year-old woman who had a left breast tumor. Fine needle aspiration cytology (FNAC) showed ML. mastectomy was performed without any adjuvant chemotherapy. histology revealed diffuse large B-cell lymphoma of REAL classification. Seventy one months after surgery, lesions indicating relapse were detected in nodes of the right axilla, mediastinum and para-aorta.She underwent eight cycles of CHOP regimen, but 1 month after the chemotherapy a brain metastasis was detected. The patient then received a high-dose methotrexate regimen with whole-skull irradiation. The second case is a 47-year-old woman who had anterior neck swelling and bilateral breast tumors. histology of the tumor revealed diffuse large B-cell lymphoma. The patient underwent eight cycles of CHOP regimen and high-dose chemotherapy (HDC) with peripheral blood stem cell transplantation (PBSCT). Forty eight months after the PBSCT, there is no evidence of disease. The third case is a 38-year-old woman who had a right breast tumor. FNAC of the breast tumor showed ML and a CT scan of the chest revealed lymphadenopathy at the crus of the diaphragm. histology of the tumor revealed low-grade B-cell lymphoma of MALT type. The patient underwent six cycles of CHOP regimen and HDC supported by PBSCT. Eighteen months after the PBSCT, relapse lesions were detected in nodes of the neck, mediastinum and renal hilum. The patient received nine cycles of a THP-COP regimen.
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keywords = neck
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20/333. A case of sarcoidosis and sarcoid granuloma, papillary carcinoma, and Graves' disease in the thyroid gland.

    sarcoidosis is a systemic chronic granulomatous disease of unknown etiology most commonly affecting young females. The disease was first described in the thyroid gland in 1938. Our patient, a 27-year-old male with known sarcoidosis, was referred to the National University Hospital for acute symptoms of thyrotoxicosis (weight loss of 6 kg, tremor, thyroid enlargement, and tachycardia). Laboratory findings showed suppressed serum thyrotropin (TSH, <0.03 mU/L [0.5-4.20]), increased total thyroxine (T4) (223 nmol/L, [60-140]), and triiodothyronine (T3) (8.5 nmol/L, [1.5-2.7]). Furthermore, Tc-99m pertechnetate scintigraphy disclosed diffuse accumulation of the isotope confirming the diagnosis of Graves' disease. During the next 18 months of antithyroid treatment (thiamazole, Thycapzol) hyperthyroidism was difficult to control, the thyroid gland gradually enlarged, and surgery was recommended. Initially, the patient declined surgery but after an additional 18 months, he accepted surgery. During the 36-month period of antithyroid drug treatment TSH was suppressed (<0.01 mU/L) and T3 often elevated despite high doses of thiamazole. Total thyroidectomy was performed, and histologic examination of the removed thyroid tissue confirmed the diagnosis of Graves' disease and also the presence of sarcoid granuloma and metastatic papillary adenocarcinoma with spread to neck lymph nodes. Four months later, a modified radical neck dissection was performed with removal of neck lymph nodes followed by external radiation therapy (2 Gy x 32 fractions to the neck). The concomitant presence of sarcoidosis, papillary carcinoma, and Graves' disease in a thyroid gland, to our knowledge, has not previously been described in the literature.
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