Squamous cell carcinoma of the head and neck: Management after excisional biopsy of a solitary metastatic neck node

A 53-year-old man was admitted for tooth mobility. A mass was identified at the tooth base by CT. Histopathology of the excisional biopsy revealed a moderately differentiated squamous cell carcinoma. Many intact neutrophils were observed within the malignant cell cytoplasm. The patient underwent partial maxillectomy and bilateral neck dissection. Significant neutrophilic emperipolesis was detected in the resected material. Four tumor recurrences developed in the head and neck region during follow-up. Surgery and chemoradiotherapy was performed. The latest tumor recurrence occurred in the peripharyngeal and the posterior parotideal region. The patient was started on pembrolizumab therapy and nearly complete treatment response occurred. Pembrolizumab was discontinued due to the adrenal insufficiency and pulmonary tuberculosis that developed as a treatment side effect. Pembrolizumab was commenced again when tumor recurrence occurred. The patient is currently alive with ongoing pembrolizumab and antituberculous treatment. We present this case to remark the presence of a significant neutrophilic emperipolesis in the squamous cell carcinoma of the hard palate and maxilla which is rarely encountered. Emperipolesis may predict tumor behavior and the consequences of immune-modulating treatment response in squamous cell carcinomas of the head and neck in regard to the findings of our case.

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Ability of Positron Emission Tomography to Detect Residual Neck Node Disease in Patients With Head and Neck Squamous Cell Carcinoma After Definitive Chemoradiotherapy

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.133.5.435 ◽

2007 ◽

Vol 133 (5) ◽

pp. 435 ◽

Cited By ~ 48

Author(s):

Ann Tan ◽

David J. Adelstein ◽

Lisa A. Rybicki ◽

Jerrold P. Saxton ◽

Ramon M. Esclamado ◽

...

Keyword(s):

Positron Emission Tomography ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Emission Tomography ◽

Definitive Chemoradiotherapy ◽

Neck Node ◽

Positron Emission ◽

Node Disease

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Oxygenation of squamous cell carcinoma of the head and neck: comparison of primary tumors, neck node metastases, and normal tissue

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(98)00182-5 ◽

1998 ◽

Vol 42 (1) ◽

pp. 35-41 ◽

Cited By ~ 80

Author(s):

Axel Becker ◽

Gabriele Hänsgen ◽

Marc Bloching ◽

Christian Weigel ◽

Christine Lautenschläger ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Normal Tissue ◽

Neck Node ◽

Primary Tumors ◽

Node Metastases

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Upregulation of PD-L1 and PD-L2 in neck node metastases of head and neck squamous cell carcinoma

Head & Neck ◽

10.1002/hed.25713 ◽

2019 ◽

Vol 41 (8) ◽

pp. 2484-2491 ◽

Cited By ~ 13

Author(s):

Julius Moratin ◽

Karl Metzger ◽

Ayse Safaltin ◽

Esther Herpel ◽

Jürgen Hoffmann ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

Neck Node ◽

Node Metastases

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Correlation between T and N Stages of Head and Neck Squamous Cell Carcinoma

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v10i4.12975 ◽

2015 ◽

Vol 10 (4) ◽

pp. 26-31

Author(s):

Krishna Koirala ◽

Bimal Sinha ◽

Dharma Kanta Baskota

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Neck Region ◽

Neck Squamous Cell Carcinoma ◽

Neck Node ◽

Head And Neck Region ◽

N Stage ◽

N Status

Background and Objective: Squamous cell carcinoma of the head and neck region is a common pathological entity. Advanced primary lesion (T) and neck node metastasis (N) both are bad prognostic features for the carcinoma. Purpose of this prospective cross sectional study is to see if T stage of primary Head and Neck squamous cell carcinoma correlates with N stage of Neck node metastasis.Materials and Methods: Patients of all ages and both sex with biopsy proven squamous cell carcinoma of Head and Neck region were included in the study. After detailed history taking and clinical examination to identify the clinical T and N status of the disease, biopsy was taken from the primary site under local or general anesthesia. Fine Needle Aspiration Cytology (FNAC) of the palpable neck node (s) was performed. Correlation of T stage of the primary tumor was seen with that of N stage of the neck by applying the statistical tests.Results: There was significant correlation of the T status of the primary head and neck carcinoma with N status of the secondary neck.Conclusion: The T status of primary head and neck squamous cell carcinoma correlates with the N status of Neck in general. By knowing the T status of the primary tumor, we can predict the nodal status in most of the cases of head and neck carcinomas which can be used in planning the treatment modalities also.JCMS Nepal 2014; 10(4):26-31

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NASOPHARYNGEAL CARCINOMA- A CLINICOPATHOLOGICAL STUDY

10.36106/ijsr/1000496 ◽

2020 ◽

pp. 1-2

Author(s):

Anchal Gupta ◽

Syed Peerzada Tehmid Ul Haque ◽

Padam Singh Jamwal

Keyword(s):

Squamous Cell Carcinoma ◽

Nasopharyngeal Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Neck Region ◽

Medical Intervention ◽

Histopathological Study ◽

Neck Node ◽

Contrast Enhanced Ct

Background: Nasopharyngeal carcinoma is commonly a squamous cell carcinoma arising from the epithelial lining of nasopharynx more frequently seen at the fossa of Rosenmüller. Materials and methods: It included 25 patients attending Department of ENT and Head & Neck Surgery, SMGS Hospital, Jammu with nasopharyngeal carcinoma from March 2017 to March 2020 were retrospectively analysed. Thorough clinical examination of the head and neck was done. Radiological examination including chest x-ray, contrast enhanced CT and/or MRI of the head and neck region was carried out. Fine-needle aspiration cytology (FNAC) from the neck node and biopsy from the nasopharyngeal mass for histopathological study was done to arrive at a diagnosis. Results: A total of 25 histopathologically confirmed cases of nasopharyngeal carcinoma were seen with a M:F ratio of 1.8:1. The peak age was found to be 30-50 years in males and 50-59 years in females. Highest incidence was in the 5th decade of life.The most common presentation is neck swelling seen in 92% patients followed by epistaxis, hearing loss and nasal obstruction.14(56%) patients were histologically diagnosed with Non Keratinizing undifferentiated, 9(36%) were Non keratinizing differentiated and 2(8%) were Keratinizing squamous cell carcinoma.15(60%) patients presented with Stage Ⅳ disease at the time of presentation,7(28%) patients presented with Stage Ⅲ disease and 3(12%) patients presented with Stage Ⅱ disease. Conclusion: Screening patients with early symptoms of NPC as it is eminently done in countries endemic for the disease, will aid in its early detection, diagnosis and curative medical intervention and thus reducing morbidity and mortality.

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