scholarly journals A Case of Radiation-Induced Multifocal Laryngeal Angiosarcoma Presenting as a Diagnostic Dilemma

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Jayme R. Dowdall ◽  
Krisha J. Opfermann ◽  
Harold Kim ◽  
Ho-Sheng Lin
Keyword(s):  
Head And Neck ◽  
Interesting Case ◽  
Unknown Primary ◽  
Small Subset ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Multiple Biopsies ◽  
Endothelial Proliferation ◽  
Radiation Induced ◽  
Previously Treated

Head and neck sarcomas are relatively rare tumors, with angiosarcomas representing a small subset. Angiosarcoma is a malignant endothelial neoplasm characterized by atypical, multilayered, or solid endothelial proliferation with vasoformative architecture. The global incidence of irradiation-associated sarcoma is estimated as between 0.03% and 0.08%. Here we reported the case of an elderly woman previously treated with radiation more than 20 years ago for an unknown primary of head and neck. This interesting case presented as a diagnostic challenge, and multiple biopsies were required to eventually establish the diagnosis of laryngeal angiosarcoma. We additionally have confirmation from our prior radiation records that the patient did, in fact, receive a substantial dose of radiation to the site previously. To our knowledge, this case represents the first report of a documented radiation-induced multifocal laryngeal angiosarcoma.

scholarly journals Sarcomatoid Lesions of Head and Neck Region: A Diagnostic Dilemma

2021 ◽  
pp. 283-293
Author(s):  
Dipankar Samaddar ◽  
Ananjan Chatterjee ◽  
. Abhinandan ◽  
Deepak Kumar ◽  
. Akriti
Keyword(s):  
Differential Diagnosis ◽  
Head And Neck ◽  
Spindle Cell ◽  
Neck Region ◽  
Spindle Cell Carcinoma ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Fracture Callus ◽  
Head And Neck Region ◽  
The Way

One challenging feature of head and neck pathology is that a dizzying array of sarcomatoid lesions occurs here ranging all the way from reactive to malignant and very aggressive. This makes accurate diagnosis critical. These lesions are quite diverse with great clinical and biological heterogeneity. Some are malignant while many others are benign or simply reactive in nature. For example; at mucosal sites, a well known lesion is spindle cell carcinoma (SpCC), which are overtly malignant, and the differential diagnosis then includes a number of different malignant spindle cell lesions. However, there are several benign or even non-neoplastic lesions that can sometimes be difficult to discern from SpCC, e.g. Nodular fasciitis, Proliferative myositis, Cellular schwannoma, Benign fibrous histiocytoma, Carcino sarcoma, Sarcomatoid melanoma. Fracture callus, etc. Aim of Study: There is a diagnostic challenge to the oral pathologists to differentiate dizzying array of sarcoma like lesions from other similar microscopic simulates ranging all the way from reactive to malignant and very aggressive. This article aims to review the sarcomatoid lesions of the head and neck region with emphasis on differential diagnosis histologically and immunohistochemicaly.

scholarly journals Primary laryngeal lymphoma: a diagnostic challenge

2021 ◽  
Author(s):  
Catarina Lombo ◽  
Carlos Matos ◽  
Rui Fonseca
Keyword(s):  
Head And Neck ◽  
B Cell Lymphoma ◽  
Final Diagnosis ◽  
Vocal Cord Palsy ◽  
Diagnostic Challenge ◽  
Multiple Biopsies ◽  
History Of ◽  
Epstein Barr ◽  
Vocal Quality ◽  
Maximal Medical Therapy

<p class="abstract">Lymphomas of head and neck constitute 5-15% of malignancies in this region. However, its primary occurrence at the larynx is exceedingly rare due to the paucity of lymphoid tissue. Here, we reported a case of a 41 year old male who presented with a 1 month history of hoarseness and odynophagia. The examination revealed right vocal cord palsy and an ipsilateral subglottic exudate, that was misdiagnosed as infectious disease. The lesion quickly progressed to airway obstruction, requiring a tracheotomy. Multiple biopsies under general anesthesia were needed before reaching the final diagnosis of diffuse large B-cell lymphoma, Epstein-Barr positive. Selected treatment modality included 3 cycles of chemotherapy followed by radiotherapy in moderate dose with complete remission after 2 years of follow up. The tracheotomy was removed, however, the patient did not recover vocal quality. This case highlighted the heterogeneous presentation of extra-nodal head and neck lymphomas and emphasized the need for suspicion of neoplasm when an infection doesn’t respond to maximal medical therapy.</p>

A Diagnostic Challenge: Gingival Lesions in a Postirradiated Nasopharyngeal Carcinoma Patient

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Sng JHT ◽  
◽  
Lum JL ◽  
Loy CHR ◽  
Yeo JF ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Head And Neck ◽  
Histopathological Analysis ◽  
Diagnostic Challenge ◽  
Carcinoma Patient ◽  
Imaging Results ◽  
Radiation Induced ◽  
Initial Imaging ◽  
Head And Neck Radiotherapy ◽  
Nasopharyngeal Carcinoma Patient

This paper shares a diagnostically challenging case of radiation-induced sarcoma that first presented as gingival ulcerations and pain in a postradiated nasopharyngeal carcinoma patient. Insufficient information from the clinical presentation and non-specific findings from initial imaging results hindered early diagnosis. Nonetheless, correlation with medical history, prompt histopathological analysis and PET-CT imaging eventually led to a definitive diagnosis. This case report aims to increase the awareness of this uncommonly known but deadly long-term complication of head and neck radiotherapy. Clinicians ought to include radiation-induced sarcoma in their list of differential diagnosis when a patient, with a history of head and neck radiotherapy, presents with persistent gingival or oral mucosa lesions, alveolar bony exposure or other suspicious dental-related symptoms.

scholarly journals Hemorrhagic Brain Metastases: A Diagnostic Dilemma and Diagnosis of Exclusion

2022 ◽  
Author(s):  
Mukta Meel ◽  
Mukesh Kumar Bhaskar ◽  
Arpita Jindal
Keyword(s):  
Brain Metastasis ◽  
Clinical Outcome ◽  
Brain Metastases ◽  
Pleomorphic Carcinoma ◽  
Unknown Primary ◽  
Diagnostic Challenge ◽  
Unique Case ◽  
Diagnostic Dilemma ◽  
Delay In Diagnosis ◽  
Primary Lung Carcinoma

AbstractPleomorphic carcinoma is a malignant and aggressive primary lung carcinoma that occurs at a rate of approximately 0.3%. This rarely encountered tumor may present a diagnostic challenge to neuroradiologists and pathologists, as it has propensity to present as hemorrhagic brain metastasis with unknown primary and result in delay in diagnosis that could impact clinical outcome. Herein, we report a unique case in its presentation in a 56-year-old female, having symptomatic brain metastasis prior to the discovery of the pulmonary lesion.

Utilization of P16 in Head and Neck Cytology and Surgical Specimens After the Release of CAP Guidelines

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S22-S22
Author(s):  
H Laharwani ◽  
V Manucha ◽  
G Jefferson ◽  
L Jackson
Keyword(s):  
Head And Neck ◽  
Squamous Cell ◽  
Squamous Cell Carcinomas ◽  
Common Reason ◽  
Unknown Primary ◽  
Hpv Testing ◽  
Neck Masses ◽  
P16 Immunohistochemistry ◽  
Hpv Status ◽  
Wrong Site

Abstract Introduction/Objective HPV-positive oropharyngeal squamous cell carcinoma is biologically and clinically unique and has a survival advantage over other head and neck squamous cell carcinomas. In December 2017 College of American Pathologist published guidelines for testing HPV status in head and neck cancer. It was recommended that pathologists perform HR-HPV testing on head and neck squamous cell carcinomas from all patients with known oropharyngeal SCC not previously tested for HR-HPV, with suspected oropharyngeal SCC, or with metastatic SCC of unknown primary. The aim of this study was to determine the compliance of pathologists following the CAP guidelines. Methods Cases that underwent HPV testing using p16 immunohistochemistry for the years 2017 and 2019 were retrieved. Based on the guidelines, p16 testing was designated as “indicated” or “not indicated”. Results There were 196 cases in which p16 testing was performed in a period of 3 consecutive years. Of these, 175 were FNA/ biopsies and 21 were surgical resections. In 69 cases (56 FNAs and 13 biopsies) the biopsy was performed on neck masses with unknown primary. The compliance for p16 testing in OPC and Lymph nodes with metastatic SCC of unknown primary was 100%. In 34 (17.3%) cases p16 testing was not indicated, the most common reason being wrong site (85%) including the larynx, oral tongue, the floor of the mouth, buccal mucosa, and nasal mass. Of the unindicated p16s, 20 (58%) were received in consultation for continuity of care. Conclusion Not being clear about the site of the tumor is the most common reason for unindicated p16 testing. A clear designation of biopsy site and proper communication between pathologist and surgeon can improve utilization of p16 testing in head and neck carcinomas.

scholarly journals Swedish National Multicenter Study on Head and Neck Cancer of Unknown Primary: Prognostic Factors and Impact of Treatment on Survival

2020 ◽  
Author(s):  
Lars Axelsson ◽  
Erik Holmberg ◽  
Jan Nyman ◽  
Anders Högmo ◽  
Helena Sjödin ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Prognostic Factors ◽  
Head And Neck ◽  
Neck Dissection ◽  
Neck Cancer ◽  
Multicenter Study ◽  
Performance Status ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
N Stage

Abstract Introduction Head and neck cancer of unknown primary (HNCUP) is a rare condition whose prognostic factors that are significant for survival vary between studies. No randomized treatment study has been performed thus far, and the optimal treatment is not established. Objective The present study aimed to explore various prognostic factors and compare the two main treatments for HNCUP: neck dissection and (chemo) radiation vs primary (chemo) radiation. Methods A national multicenter study was performed with data from the Swedish Head and Neck Cancer Register (SweHNCR) and from the patients' medical records from 2008 to 2012. Results Two-hundred and sixty HNCUP patients were included. The tumors were HPV-positive in 80%. The overall 5-year survival rate of patients treated with curative intent was 71%. Age (p < 0.001), performance status (p= 0.036), and N stage (p= 0.046) were significant factors for overall survival according to the multivariable analysis. Treatment with neck dissection and (chemo) radiation (122 patients) gave an overall 5-year survival of 73%, and treatment with primary (chemo) radiation (87 patients) gave an overall 5-year survival of 71%, with no significant difference in overall or disease-free survival between the 2 groups. Conclusions Age, performance status, and N stage were significant prognostic factors. Treatment with neck dissection and (chemo) radiation and primary (chemo) radiation gave similar survival outcomes. A randomized treatment study that includes quality of life is needed to establish the optimal treatment.

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