Cases reported "Neoplasm Metastasis"

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11/115. Malignant fibrous histiocytoma of the nasal cavity and paranasal sinuses.

    Malignant fibrous histiocytomas are uncommon in the head and neck, the sinonasal tract being the most common location. This report describes 5 cases in this area: two in the nasal cavity, two in the maxillary sinus, and one in the frontal sinus. Four were primary cases and one was secondary to previous irradiation. All patients received surgical treatment, one of them with postoperative irradiation. All five patients experienced local recurrences and three also experienced distant metastases. Only one of these recurrences was successfully salvaged and the patient is alive and free of disease 3 years after resection. A summary of knowledge about the entity is reviewed.
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keywords = neck
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12/115. Recurrent cardiac myxoma with multiple distant metastasis and malignant change.

    A 37 year-old female underwent open heart surgery for a left atrial myxoma. The post-operative course was uneventful and she was discharged two weeks later. She had regular monthly follow-up in the outpatient department until 10 months postoperatively when she was readmitted to the orthopedic ward for excision of a left ankle tumor. Two days after admission, she developed severe orthopnea. The initial diagnosis was heart failure, and she was transferred to the medical ward for treatment. Transthoracic and transesophageal echocardiography revealed a recurrent left atrial tumor. Because of acute obstruction of the mitral valve and deterioration of her condition, she underwent emergent open heart surgery. The recurrent atrial tumor was excised; histopathologic examination revealed a myxoid sarcoma. Multiple tumors were found on this admission, including a mass in the neck and in the left forearm; computed tomography revealed a brain tumor in the left posterior frontal lobe and a chest wall tumor. She died two months later. Recurrent cardiac myxoma with multiple distant metastasis may have a malignant potential. Because of the potential for tumor recurrence, long-term and regular follow-up is mandatory.
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13/115. An unusual presentation of non-Hodgkin's lymphoma in the head and neck.

    The lymphomas are a group of lymphoproliferative disorders that can be divided histologically in the two main groups of Hodgkin's and non-Hodgkin's lymphoma. They sometimes present in the head and neck, and the diagnosis and management require a multidisciplinary approach. An unusual case is described presenting at an advanced stage because of patient delay in seeking medical help.
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keywords = neck
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14/115. Catastrophic necrosis of the neck.

    This case report illuminates the high possibility of catastrophic complications in the lateral neck, the vagaries associated with the preoperative therapeutic information, the technical effort to gain maximum surgical security, and the overwhelming complications associated with chemotherapy, irradiation, and surgical intervention.
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15/115. Papillary thyroid carcinoma metastatic to the parapharyngeal space.

    Nodal metastases from head and neck primary cancer presenting as a parapharyngeal space mass are rare. This paper reports two cases of papillary thyroid carcinoma metastatic to the parapharyngeal space. This finding can be related to Rouviere's description of a direct lymphatic pathway from the posterior surface of the superior thyroid lobe to the lateral retropharyngeal nodes. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal space mass.
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keywords = neck
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16/115. A long-term survivor of leiomyosarcoma around the right side of the base of the skull: effective radiotherapy combined with intra-arterial chemotherapy.

    We report a rare case of a leiomyosarcoma that developed around the right side of the base of the skull in a 51-year-old woman. The patient consulted our hospital complaining of pain in the right side of her neck and upper right arm in August 1994. A leiomyosarcoma, originating around the right side of the neck and base of the skull was diagnosed. Initially, surgery was planned, but invasion into the spinal canal was discovered. Curative resection of the leiomyosarcoma around the right side of the base of the skull was not possible. Therefore, external beam radiotherapy (EBRT) combined with intra-arterial chemotherapy and hyperthermia was employed. After the treatment, the tumor decreased in size to 45% of its initial volume, and, simultaneously, her symptoms completely disappeared. The patient initially remained clinically free of the disease, but showed reaggravations at the primary tumor site 3 years and 3 months, and 4 years and 11 months, after the first treatment. The reaggravations were treated with EBRT combined with intra-arterial chemotherapy. As a result, she survived for 5 years and 7 months after the first treatment.
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keywords = neck
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17/115. 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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keywords = neck
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18/115. Aggressive squamous cell carcinomas in persons infected with the human immunodeficiency virus.

    OBJECTIVES: To illustrate the potential for aggressive growth of cutaneous squamous cell carcinomas (SCCs) in patients infected with the human immunodeficiency virus (hiv) and to determine the factors associated with increased morbidity and mortality from aggressive SCCs in hiv-infected patients. DESIGN: Retrospective nonrandomized case series. SETTING: University-based dermatologic referral center. patients: A consecutive sample of 10 patients infected with hiv who had "aggressive" SCC based on the following criteria: diameter larger than 1.5 cm, rapid growth rate, local recurrence, and/or evidence of metastasis. MAIN OUTCOME MEASURES: morbidity and mortality. RESULTS: Five patients died of metastatic SCC within 7 years of their initial diagnosis despite treatment. Human immunodeficiency virus stage and the degree of immunosuppression were not associated with increased morbidity and mortality. patients initially undergoing combination surgery and radiation therapy or radical neck dissection had the best outcomes. CONCLUSIONS: patients infected with hiv can develop rapidly growing cutaneous SCCs at a young age, with a high risk of local recurrence and metastasis. High-risk SCCs should be managed aggressively and not palliatively in patients infected with hiv.
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keywords = neck
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19/115. Sarcoma of the thyroid gland: a case report.

    Sarcoma of the thyroid gland is a very uncommon malignant tumor (<1% of thyroid cancers) characterized by severe local course and rapid metastatic dissemination and very poor prognosis. We report the case of an 84-year-old woman hospitalized for expiratory dyspnea, severe malnutrition and swallowing disorders leading to bronchial infection. She had a voluminous (20 cm) extra-thoracic right-neck goiter with a considerable superficial venous pattern that had developed on an old goiter before growing recently. CEA and calcitonin levels were normal. The cervical-thoracic CT demonstrated a partially necrosed heterogeneously hypodense tumor compressing the esophagus and the trachea with displacement of adjacent structures which were not directly invaded. Large areas of necrosis and a probable metastatic image measuring 3 cm in the right median pulmonary lobe were observed. Macrobiopsy disclosed grade 3 sarcoma. Complete resection delivered a 3.170 kg tumor. histology confirmed the diagnosis of sarcoma without neoplastic extension. Apart from right recurrent palsy, the initial post-operative period was satisfactory and the patient was discharged. Four and a half months later she was rehospitalized with local recurrence with a large metastatis in the right lung. She died two weeks later.
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20/115. adult neuroblastoma. Electron microscopic observations in nine cases.

    Nine patients, whose ages ranged from 18 to 72, had small round cell neoplasms which were found on electron microscopy to have the ultrastructural features of neuroblastoma. The primary tumor was retroperitoneal in one patient. In another, liver and bone metastases were present and the primary site was not determined. The tumor presented in a peripheral location in the remaining seven patients (leg in two, buttock in one, head and neck in four), and all seven tumors metastasized to regional lymph nodes. One tumor that arose in the nasal cavity displayed olfactory differentiation. Two tumors recurred locally following excision. Although two patients have died from disseminated disease, the prognosis nevertheless appears more favorable than in childhood neuroblastoma. Adequate local excision of a peripheral lesion with close follow-up are indicated.
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