Cases reported "Oropharyngeal Neoplasms"

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1/37. Clinical delivery of intensity modulated conformal radiotherapy for relapsed or second-primary head and neck cancer using a multileaf collimator with dynamic control.

    BACKGROUND AND PURPOSE: Concave dose distributions generated by intensity modulated radiotherapy (IMRT) were applied to re-irradiate three patients with pharyngeal cancer. patients, MATERIALS AND methods: Conventional radiotherapy for oropharyngeal (patients 1 and 3) or nasopharyngeal (patient 2) cancers was followed by relapsing or new tumors in the nasopharynx (patients 1 and 2) and hypopharynx (patient 3). Six non-opposed coplanar intensity modulated beams were generated by combining non-modulated beamparts with intensities (weights) obtained by minimizing a biophysical objective function. Beamparts were delivered by a dynamic MLC (Elekta Oncology Systems, Crawley, UK) forced in step and shoot mode. RESULTS AND CONCLUSIONS: Median PTV-doses (and ranges) for the three patients were 73 (65-78), 67 (59-72) and 63 (48-68) Gy. Maximum point doses to brain stem and spinal cord were, respectively, 67 Gy (60% of volume below 30 Gy) and 32 Gy (97% below 10 Gy) for patient 1; 60 Gy (69% below 30 Gy) and 34 Gy (92% below 10 Gy) for patient 2 and 21 Gy (96% below 10 Gy) at spinal cord for patient 3. Maximum point doses to the mandible were 69 Gy for patient 1 and 64 Gy for patient 2 with, respectively, 66 and 92% of the volume below 20 Gy. A treatment session, using the dynamic MLC, was finished within a 15-min time slot.
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2/37. Waldeyer's ring lymphoma presenting as massive oropharyngeal hemorrhage.

    A case report of a patient presenting with massive oropharyngeal hemorrhage originating from lymphoma of the tonsil and it's management is discussed. Locally advanced or recurrent squamous cell carcinoma may manifest with massive oropharyngeal hemorrhage, however, it is unusual for Waldeyer's ring lymphoma to present in this fashion. Management of oropharyngeal malignancies presenting in this manner includes airway control, control of hemorrhage, and biopsy of the tumor. hemorrhage control is provided by surgical exploration or intraarterial embolization. Extranodal lymphoma of the head and neck is not uncommon and is thoroughly discussed in the medical literature. hemorrhage into the upper aerodigestive tract is occasionally observed in the patient with head and neck cancer. It usually occurs, however, in patients with squamous cell carcinoma that have been previously treated or in patients with locally advanced cancers. A comprehensive review of the literature has revealed no other reports of head and neck lymphoma presenting with massive oropharyngeal hemorrhage.
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3/37. Spindle cell angiosarcoma of the oropharynx.

    Angiosarcomas are uncommon malignant tumours of vascular endothelium. In the head and neck, the scalp is the commonest site of origin. A rare case of spindle-cell angiosarcoma of the oropharynx, treated by surgery and post-operative radiotherapy, is reported. We discuss the clinical presentation and histopathological diagnosis of this lesion.
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4/37. Pulmonary lymphangitic carcinomatosis from an oropharyngeal squamous cell carcinoma: a case report.

    Pulmonary lymphangitic carcinomatosis (PLC), a form of lymphatic spread of cancer cells, from head and neck cancers is extremely rare. We report here a case of PLC from an oropharyngeal squamous cell carcinoma in a 68-year-old man. The patient underwent inductive chemoradioimmunotherapy which resulted in complete tumor remission. The tumor, however, recurred 6 months later and was resected. Late metastasis occurred in the ipsilateral cervical lymph nodes 13 months post surgery and these lymph nodes were dissected. Three months later, the patient suffered from a fever, cough and dyspnea and a chest radiograph revealed an interstitial linear pattern from the right hilum to the right upper lung field. Without diagnosis of the pulmonary lesion, swelling of the bilateral lymph nodes followed after a few months and dyspnea worsened with spread of the reticular shadow and appearance of Kerley's B line on the roentgenogram, suggesting PLC. The patient gradually became more distressed and finally died 6 months after the onset of dyspnea. The microscopy of the autopsied pulmonary tissue revealed tumor cell nests in the lymph vessels in the septa and the pulmonary lesion was histopathologically diagnosed as PLC. The present case indicates that we should consider PLC when cough and dyspnea with reticular shadows and Kerley's B line are observed in patients with head and neck carcinoma.
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5/37. Local treatment of AIDS-associated bulky Kaposi's sarcoma in the head and neck region.

    Kaposi's sarcoma (KS) is frequently seen in the head and neck regions of hiv-infected patients. We report two cases of patients with AIDS who consulted the ENT clinic. One patient came to our clinic complaining of abnormal sensations in the pharynx, and dysphasia due to a gross KS in the oropharynx. The excision of the tumor improved the difficulty of swallowing. The other patient complained of masticatory problems and tongue pain due to a bulky KS on the dorsal side of the tongue. We treated the tongue lesion with intralesional chemotherapy. The administration of intralesional vinblastine resulted in a partial response. Unless systemic chemotherapy is effective enough to improve a functional disorder, it is thought that local therapy employing excision or intralesional chemotherapy is one of the common therapeutic option of the otolaryngologist, because this treatment avoids severe side effects caused by systemic chemotherapy or radiotherapy.
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6/37. Intracranial metastases in patients with squamous cell carcinoma of the head and neck.

    BACKGROUND: Intracranial metastases are rarely clinically diagnosed in patients with head and neck squamous cell carcinoma. Only 7 patients with metastases to the cavernous sinus from head and neck squamous cell carcinomas have been reported. methods: A retrospective study revealed 13 patients with intracranial metastases of head and neck squamous cell carcinoma. In a 53-year-old woman a cavernous sinus metastasis of a laryngeal carcinoma was histologically diagnosed by using a CT-guided surgical navigation system and was treated with stereotactic radiotherapy. RESULTS: The mean survival was 4.3 months. Predictive factors for longer survival were absence of extracranial disease, age younger than 60 years, and treatment with radiotherapy. CONCLUSIONS: The prognosis for patients with intracranial disease is poor. The current development of computer-assisted stereotactic navigation and stereotactic radiotherapy may facilitate surgical diagnostic exploration and improve treatment, especially in patients without extracranial disease.
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7/37. Mandibular metastasis from renal cell carcinoma. A case report.

    Renal cell carcinoma (RCC) metastasizing to the mandible and subsequently spreading to oropharynx in a 62 year old man is reported. The patient presented with solitary mandibular lesion with hematuria, which on further investigation was diagnosed to be RCC with no other systemic involvement. Clinical manifestation of the mandibular metastasis from RCC is rarely seen. A case is reported and literature regarding extracranial head and neck metastasis by RCC is reviewed.
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8/37. Dysphagia due to a large schwannoma of the oropharynx: case report and review of the literature.

    Schwannoma is a benign, encapsulated tumor that is derived from schwann cells. Approximately 25% to 45% of schwannomas occur in the head and neck. The most common site is the parapharyngeal space of the neck; intrapharyngeal occurrence is extremely rare. To our knowledge, this is the first report of a pedunculated schwannoma in the supraglottic oropharynx. Because of the location and mass of the tumor, the main symptom was dysphagia. The tumor was excised via direct microlaryngoscopy, and no recurrence was seen after 2 years of follow-up. When schwannomas are located in the pharynx, they may cause dyspnea and dysphagia or impair phonation. Therefore, when dysphagia is present, a thorough diagnostic procedure should be performed to evaluate the morphology and function of the upper aerodigestive tract.
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9/37. Feasibility of sentinel lymph node radiolocalization in neck node-negative oral squamous cell carcinoma patients.

    We examined the reliability of the use of lymphoscintigraphy (LS) and a hand-held gamma probe (GP) to identify the sentinel lymph node (SLN), and sequentially determined the feasibility of SLN radiolocalization in clinical neck node-negative oral squamous cell carcinoma (SCC) patients. A radiolabel with the unfiltered (99m)Tc tin colloid was injected submucosally around the primary site followed by LS at 2-hour intervals. Preoperative localization was performed with GP. After en bloc removal of the regional lymphatics, histopathologic results for the nodes were compared with the SLN radiolocalization. The LS and GP counts were well correlated, and there was concordance between SLN and neck node status in 7 of 8 cases (87.5%). We thus considered that our concept in this study was valid in determining the necessity for neck dissection for those node-negative oral SCC patients.
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10/37. Fanconi's anemia and clinical radiosensitivity report on two adult patients with locally advanced solid tumors treated by radiotherapy.

    BACKGROUND: patients with Fanconi's anemia (FA) may exhibit an increased clinical radiosensitivity of various degree, although detailed clinical data are scarce. We report on two cases to underline the possible challenges in the radiotherapy of FA patients. CASE REPORT AND RESULTS: Two 24- and 32-year-old male patients with FA were treated by definitive radiotherapy for locally advanced squamous cell head and neck cancers. In the first patient, long-term tumor control could be achieved after delivery of 67 Gy with a-in part-hyperfractionated split-course treatment regimen and, concurrently, one course of carboplatin followed by salvage neck dissection. Acute toxicity was marked, but no severe treatment-related late effects occurred. 5 years later, additional radiotherapy was administered due to a second (squamous cell carcinoma of the anus) and third (squamous cell carcinoma of the head and neck) primary, which the patient succumbed to. By contrast, the second patient experienced fatal acute hematologic toxicity after delivery of only 8 Gy of hyperfractionated radiotherapy. While the diagnosis FA could be based on flow cytometric analysis of a lymphocyte culture in the second patient, the diagnosis in the first patient had to be confirmed by hypersensitivity to mitomycin of a fibroblast cell line due to complete somatic lymphohematopoietic mosaicism. In this patient, phenotype complementation and molecular genetic analysis revealed a pathogenic mutation in the FANCA gene. The first patient has not been considered to have FA until he presented with his second tumor. CONCLUSION: FA has to be considered in patients presenting at young age with squamous cell carcinoma of the head and neck or anus. The diagnosis FA is of immediate importance for guiding the optimal choice of treatment. radiotherapy or even radiochemotherapy seems to be feasible and effective in individual cases.
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