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1/78. Esophageal carcinoma following radiotherapy.

    A patient previously irradiated for epiglottic cancer developed an upper esophageal stricture that on biopsy proved to be a moderately differentiated squamous cell carcinoma. patients receiving prior radiotherapy for a head and neck cancer are at increased risk of developing a second esophageal cancer and must be followed closely.
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2/78. Late sequelae of radiation therapy in cancer of the head and neck with particular reference to the nasopharynx.

    Sequlae of radiation therapy may be late in occurring and varied in their manifestations. Although some are untreatable and progressive, the risk of development of some other sequelae can be minimized by careful application of radiotherapy or by ancillary measures, such as dental decay prophylaxis. Some of the serious sequelae secondary to radiation therapy of the nasopharynx have been summarized. These include radiation myelitis, paralysis of the cranial nerves, stricture of the pharynx, radiation-induced cancer, and necrosis with fatal hemorrhage.
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3/78. radiation-induced malignant fibrous histiocytoma of the neck in a patient with laryngeal carcinoma.

    Fibrohistiocytomas are soft tissue tumors of histiocytic origin that have a variety of histological patterns. Although cases of malignant fibrous histiocytoma (MFH) of the head and neck have been reported with increasing frequency in recent years, they are considered rare. We report a case of the giant cell variant of MFH of the neck in which the patient had been given radiotherapy for T1 glottic cancer. prognosis of MFH, the use of radiation as primary treatment, and its role in the development of secondary primary tumors in the head and neck region are reviewed. [editorial comment: The authors stress the important relationship between prior radiation therapy and the induction of new tumors.]
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4/78. Rare incidence of three consecutive primary tumors in the maxillofacial region: retinoblastoma, leiomyosarcoma, and choriocarcinoma: case report.

    Multiple primary tumors occur more commonly in the region of the head and neck than elsewhere in the body. The chance of this is particularly high in patients treated for retinoblastoma, in part because of a genetic predisposition, and in part because of the possibility of irradiation treatment. However, triple tumors occur in only 0.5% of multiple tumors. A rare case of a triple (metachronous) tumor is reported: 12 years after the treatment of bilateral retinoblastoma (enucleation and irradiation), secondary leiomyosarcoma developed in the maxillofacial region, followed 5 years later by choriocarcinoma. Surgery was performed on all three types of tumor. As a result, the female patient (currently 21 years old) is now free of complaints and has married. It is extremely rare for either leiomyosarcoma or choriocarcinoma (CHC) to appear in the maxillofacial region. The long-term, systematic control of such patients is absolutely necessary, for the multiple tumors tend to develop only after a long latency period of 10 to 20 years.
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5/78. Cancer of the thyroid following radium application to the neck.

    A young patient, suffering from thyroid carcinoma 24 years after radium treatment of the neck, is presented. The cancer appeared in the area which has been irradiated. In the present case, the thyroid was exposed to a relatively low dose of radiation. The importance of ionizing radiation and its carcinogenic effect in the juvenile thyroid are discussed.
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6/78. Early-onset postirradiation sarcoma of the head and neck: report of three cases.

    Postirradiation sarcomas of the head and neck are rare. When they do occur, most appear at least 10 years following radiation therapy. We report three cases of early-onset (1, 2, and 7 yr) postirradiation sarcoma. physicians who care for previously irradiated patients should consider the possibility of a postirradiation sarcoma whenever they see a suspicious lesion, regardless of the amount of time that has passed since radiation therapy was administered. The original pathology should be reexamined to ensure that the original tumor was diagnosed correctly. Electron microscopy can be useful in differentiating sarcomatous-appearing epithelial lesions from true soft-tissue sarcomas, and thus can be helpful in guiding therapy.
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7/78. Treated Wilm's tumor in childhood as potential risk factor for second thyroid cancer.

    The potential risk of a treatment-induced second neoplasia affecting the thyroid is well known after radiation therapy for several types of cancer, but few cases have been related to incidental irradiation for Wilms' tumor. We report a case of a papillary thyroid carcinoma discovered in a young patient 15 years after treatment of a Wilms' tumor. An 18-year-old man was referred to our Endocrinological Department for a single 3 cm nodule in the right lobe of the thyroid. His past medical history included at the age of 2 years surgical resection, chemotherapy (actinomycin-D and vincristine) and cesium radiation therapy to the right side for a Wilms' tumor in stage III: a total dose of 7700 rads was delivered to an area of 17 x 10 cm in the right flank. After fine-needle demonstration of a follicular thyroid lesion, the patient underwent right lobectomy, followed by total thyroidectomy for histologic diagnosis of a follicular variant papillary cancer. Residual thyroid tissue was ablated by iodine-131 administration (3700 MBq), but scanning after therapeutic iodine showed radioactive uptake in the left regional lymph nodes, with elevated serum thyroglobulin off therapy (830 ng/ml). magnetic resonance imaging confirmed the presence of lymph node enlargements and bilateral neck dissection was performed, followed by radioiodine treatment (3700 MBq) and thyroxine suppressive therapy. After 3-year follow-up the patient is disease-free. Although few cases of thyroid cancer have been reported in the literature after irradiation for a Wilms' tumor during childhood, this association should be considered in the long-term follow-up.
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8/78. Irradiation-induced polyglandular neoplasia of the head and neck.

    Eighteen patients are presented with twenty-one tumors of the head and neck, which include ten salivary gland tumors and eight parathyroid adenomas. Eight of the patients also had thyroid neoplasms. All patients had a history of prior irradiation to the head and neck. Seventy per cent of the salivary gland tumors and 37 per cent of the thyroid tumors were malignant. Recommendations are made for detection and treatment.
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9/78. Malignant fibrous histiocytoma of the head and neck after radiation for squamous cell carcinoma.

    A 60-year-old man presented with malignant fibrous histiocytoma of the oropharynx. The mass extended into the nasopharynx and larynx and caused severe upper airway obstruction that required emergency tracheotomy. Ten years earlier, he had undergone a right partial glossectomy and segmental mandibulectomy for squamous cell carcinoma of the right tongue base,followed by 50 Gy of radiation delivered over 33 sessions. The tumor was so aggressive that changes in its volume were visually distinguishable during physical examination over a 2-week hospital stay. Histologic evaluation revealed 7 mitotic figures per high-power field. Although radiation-induced malignant fibrous histiocytoma is rare in the head and neck, the recent medical literature indicates that its incidence is rising. This rise has been attributed to the increased effectiveness of head and neck cancer therapy, which results in prolonging patients' survival and, hence, their risk of subsequent disease. Because malignant fibrous histiocytoma is a late complication of radiation therapy, appearing on average 10 years following treatment, it is important that physicians who treat head and neck cancer monitor these patients over the long term and remain alert for its appearance, even despite the apparent "cure" of their original neoplasm.
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ranking = 7
keywords = neck
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10/78. Papillary adenocarcinoma in thyroid hemiagenesis.

    Variation in the gross anatomy of the thyroid gland is relatively common. Although thyroid hemiagenesis is felt to be a rare anomaly, its incidence is probably underestimated as the diagnosis is usually incidental. The case of a 41-year-old woman with right thyroid hemiagenesis associated with papillary adenocarcinoma is presented. The diagnosis of hemiagenesis was established by isotope imaging and surgical exploration for a benign nodule. Seven years later she was seen with a recurrent neck mass, and an isotope scan revealed it to be a cold thyroid nodule. As she was diagnosed to have papillary adenocarcinoma, total thyroid lobectomy was performed and at present she remains disease-free.
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