Lessons Learned from Patients: Two Cases

A 4-year-old white girl was entirely well until Jan 8, 1979, when her temperature was 104 F. Other symptoms included nasal congestion, slight cough, and pain in the right ear. On physical examination her right ear drum was moderately inflamed and bulging. Her tonsils were large and red, but no exudate was present. Tender anterior cervical lymph nodes, 2 x 2 cm, were palpable bilaterally. Her chest was clear. There was a grade 1/6 systolic murmur along the left sternal border (LSB) which had been heard on previous examinations and was thought to be innocent in nature. Her spleen was not palpable.

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Aseptic Meningitis in the Decennium of Borrelia burgdorferi Infection (Lyme Disease)

PEDIATRICS ◽

10.1542/peds.87.2.268a ◽

1991 ◽

Vol 87 (2) ◽

pp. 268-269

Author(s):

CHRISTOPH AUFRICHT ◽

WILLI TENNER ◽

GEROLD STANEK

Keyword(s):

Lyme Disease ◽

Borrelia Burgdorferi ◽

Physical Examination ◽

Lymph Nodes ◽

Sore Throat ◽

Aseptic Meningitis ◽

Cervical Lymph Nodes ◽

Nuchal Rigidity ◽

History Of ◽

The Right

To the Editor.— A 7-year-old boy with a 2-week history of fatigue, sore throat, and swelling of the right cheek was admitted to our hospital in May 1989. He had no history of intoxication, trauma, fever, or bite. He lived in Vienna and did not travel outside Austria.1 His mother was concerned about his irritability and emotional liability. Physical examination revealed mild hyperemia of his pharynx and ear drums. There were enlarged cervical lymph nodes and mild nuchal rigidity.

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Ocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes

European Journal of Ophthalmology ◽

10.1177/1120672119870079 ◽

2019 ◽

pp. 112067211987007

Author(s):

Jayati Sarangi ◽

Aanchal Kakkar ◽

Diya Roy ◽

Rishikesh Thakur ◽

Chirom Amit Singh ◽

...

Keyword(s):

Lymph Nodes ◽

Histopathological Examination ◽

Previous History ◽

Rare Presentation ◽

Cervical Lymph Nodes ◽

Extranodal Extension ◽

Positron Emission ◽

Parotid Neoplasm ◽

History Of ◽

The Right

Purpose: To describe a rare presentation of a case of intraocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes. Case description: A 9-year-old male child with previous history of ciliary body non-teratoid medulloepithelioma presented with a swelling in the right pre-auricular region for 1 month. Magnetic resonance imaging and positron emission tomography–computed tomography showed a right intraparotid mass with enlarged ipsilateral cervical lymph nodes. A core biopsy was taken from the lesion, which on microscopy showed a tumor composed of small round cells arranged in cords, tubules lined by multilayered cells, and in cribriform pattern. These cells were embedded in a hypocellular, loose myxoid matrix. Based on the histopathological characteristics and previous history, a diagnosis of medulloepithelioma metastastic to ipsilateral parotid gland was made. The patient underwent right total conservative parotidectomy and bilateral neck dissection. Histopathological examination revealed metastatic medulloepithelioma in five out of eight intraparotid lymph nodes, with extranodal extension into the adjacent parotid parenchyma. Foci of hyaline cartilage were identified within the tumor, leading to a diagnosis of metastatic teratoid medulloepithelioma. Conclusion: Intraparotid lymph node metastases from intraocular medulloepithelioma is a rare possibility and we recommend that the parotid should be evaluated in cases of intraocular medulloepithelioma at initial presentation as well as during the follow-up period. Also, metastasis should be considered in all pediatric patients with solitary mass lesions showing unconventional histology for a primary parotid neoplasm.

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Extracranial Metastases of Oligodendroglioma

Neurosurgery ◽

10.1227/00006123-198103000-00012 ◽

1981 ◽

Vol 8 (3) ◽

pp. 391-396 ◽

Cited By ~ 22

Author(s):

Nelson G. Ordóñez ◽

Alberto G. Ayala ◽

Milam E. Leavens

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Lymph Nodes ◽

Masseter Muscle ◽

Lumbar Vertebrae ◽

Cervical Lymph Nodes ◽

Extraneural Metastases ◽

The Central Nervous System ◽

The Right ◽

Extracranial Metastases

Abstract The case of a 33-year-old woman with oligodendroglioma with extraneural metastases involving the masseter muscle, the cervical lymph nodes, the lumbar vertebrae, and the right iliac bone is described. Oligodendroglioma with metastases outside the central nervous system is extremely rare, and only a very few cases have been reported.

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Postoperative recurrence with right cervical lymph node metastasis in hepatocellular carcinoma: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01352-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kiyonori Tanoue ◽

Yota Kawasaki ◽

Yoichi Yamasaki ◽

Satoshi Iino ◽

Masahiko Sakoda ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Lymph Node ◽

Lymph Nodes ◽

Cervical Lymph Node ◽

Metastatic Lymph Node ◽

Cervical Region ◽

Cervical Lymph Nodes ◽

Lymph Node Recurrence ◽

Metastatic Lymph ◽

The Right

Abstract Background Hepatocellular carcinoma (HCC) patients with metastases to the cervical lymph nodes are extremely rare, and its clinical course is characterized by rapidly progressive disease. Hence, there have been no reports of metastatic cervical lymph node recurrence indicated after a long postoperative surveillance period. Case presentation The patient was a 63-year-old male who underwent right hepatectomy for HCC of the right upper lobe. Three years after resection, metastatic lymph node recurrence was detected in the subdiaphragm, superior mediastinum, and right cervical lymph nodes. The patient underwent excisional biopsy of the cervical lymph node, followed by molecular-targeted therapy and radiation therapy. Lenvatinib reduced the size of all metastatic lymph nodes and the patient survived for a relatively long period of 43 months after the recurrence was detected. Conclusions After resection of HCC in the right upper lobe, there is the possibility of metastatic lymph node recurrence in unusual sites, including the cervical region, and lenvatinib may be effective in those recurrences.

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Migration of Teflon after Vocal Cord Injection

Otolaryngology ◽

10.1177/019459988709600111 ◽

1987 ◽

Vol 96 (1) ◽

pp. 63-66 ◽

Cited By ~ 35

Author(s):

John C. Ellis ◽

Thomas V. Mccaffrey ◽

Lawrence W. Desanto ◽

Herbert V. Reiman

Keyword(s):

Cerebral Cortex ◽

Lymph Nodes ◽

Vocal Cord ◽

Vocal Fold ◽

Mediastinal Lymph Nodes ◽

Polarizing Microscopy ◽

Cervical Lymph Nodes ◽

Upper Cervical ◽

The Right

Each of eight mongrel dogs received a 0.5 ml injection of polytef paste into the right vocal fold. These dogs were killed at 1 week, 1 month, 3 months, and 6 months after injection, and a number of organs were examined. Polarizing microscopy was used to examine the upper cervical lymph nodes, lower cervical lymph nodes, mediastinal lymph nodes, abdominal lymph nodes, cerebral cortex, brainstem, lung, liver, spleen, and kidney to determine if migration of polytef had occurred. Examination of these organs revealed that there was consistent migration of polytef particles into the cervical lymph nodes, with the highest incidence occurring in upper cervical lymph nodes on the side of injection. There was no evidence of migration of polytef particles to distant sites. The study shows that polytef particles may migrate to cervical lymph nodes after injection into the larynx; however, there is no evidence of distant migration.

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Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review

Open Medicine ◽

10.1515/med-2021-0246 ◽

2021 ◽

Vol 16 (1) ◽

pp. 428-434

Author(s):

Jing Wang ◽

Li Ma ◽

Jianghong Guo ◽

Yanfeng Xi ◽

Enwei Xu

Keyword(s):

Partial Response ◽

Literature Review ◽

Lymph Nodes ◽

Burkitt Lymphoma ◽

Complete Response ◽

Clinicopathological Features ◽

Cervical Lymph Nodes ◽

Cervical Mass ◽

The Right

Abstract Objective The aim of this study is to evaluate the clinicopathological features and the treatment of the Burkitt-like lymphoma with 11q aberration. Methods We reported two patients with Burkitt-like lymphoma with 11q aberration: a 56-year-old man with AIDS (case 1) and a 37-year-old woman (case 2) without AIDS. The biopsy of cervical lymph nodes showed Burkitt-like morphologic and immunophenotypic features. But both of them lack MYC rearrangement and carry an 11q-arm aberration with proximal gains and/or telomeric losses. The diagnosis was confirmed by pathological morphology, immunohistochemistry, and fluorescence in situ hybridization. Result After a cycle of R-CTOEP (rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisone) chemotherapy, case 1 refused to chemotherapy and radiotherapy and was followed up for 34 months without recurrence and new focus. Case 2 received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for two cycles and achieved PR (partial response). Then, the patient in case 2 received EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) for three cycles, and the right cervical mass disappeared. She achieved complete response and was followed up for 16 months without recurrence and new focus. Conclusion Burkitt-like lymphoma with 11q abnormalities resembles Burkitt lymphoma morphologically but lacks MYC rearrangement and may have a better prognosis.

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Thyroid metastases from breast carcinoma: case report and review of literature

10.21203/rs.3.rs-45880/v1 ◽

2020 ◽

Author(s):

Yichao Wang ◽

Shengliang Zhou ◽

Boyang Yu ◽

Ping Zhou ◽

Zhihui Li ◽

...

Keyword(s):

Breast Carcinoma ◽

Lymph Nodes ◽

Distant Metastases ◽

Needle Aspiration ◽

Thyroid Lesion ◽

Cervical Lymph Nodes ◽

Left Chest ◽

History Of ◽

Thyroid Metastases ◽

The Right

Abstract Rationale: The thyroid is a rare site for distant metastases from breast carcinoma. The incidence of thyroid metastases in fine needle aspiration biopsy (FNAB) was less than 0.2%.Patient concerns: We report a case of 54-year-old woman with a history of breast carcinoma presented with diffuse scattered microcalcifications in thyroid and enlarged bilateral cervical lymph nodes detected on ultrasound (US). Physical examination of the patient revealed stiff and enlarged thyroid lobes.Diagnoses: FNAB and immunohistochemistry （IHC）of the thyroid lesion confirmed the thyroid metastases from breast cancer.Interventions and outcomes: Due to the comorbidities of breast carcinoma metastases to the right axillary, cervical lymph nodes and left chest wall, the patient received chemotherapy. After a follow-up of 10 months, the patient was alive without any new distant metastases.Lessons: Our case highlights that thyroid metastases should be considered in a patient combined with thyroid lesions and a history of breast carcinoma. IHC played an important role in differentiating thyroid metastases from primary thyroid cancer.

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A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1251 ◽

2015 ◽

Vol 6 (4) ◽

pp. 181-186

Author(s):

Adam D Fisher ◽

Shawn A McClure ◽

Johnny Franco

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Unknown Primary ◽

Low Grade ◽

Primary Squamous Cell Carcinoma ◽

Cervical Lymph Nodes ◽

The Right

ABSTRACT Background This is a case report of synchronous, noncollision head and neck malignancies, consisting of a large polymorphous low-grade adenocarcinoma (PLGA) and an unknown primary squamous cell carcinoma (SCC) that was diagnosed on final pathology. Materials and methods Positron emission tomography– computed tomography (CT) scan with and without contrast was obtained, which showed a large destructive soft tissue mass emanating from the right maxilla into the right maxillary sinus with invasion into the surrounding tissue and bone, compatible with an underlying primary maxillary malignancy. Increased D-18 fluorodeoxyglucose activity was also seen in the neck corresponding to numerous bilateral cervical lymph nodes. Magnetic resonance imaging showed the extent of the soft tissue mass, which expanded to the inferior aspect of the right orbital floor, with no evidence of gross invasion into the orbit. Results The patient underwent a subtotal maxillectomy, bilateral modified radial neck dissection, and reconstruction. Pathology revealed metastatic PLGA present in the right cervical lymph nodes. Left cervical lymph nodes, however, revealed metastatic SSC. The patient was taken back to the operating room and a panendoscopy was performed. Physical examination was benign and multiple biopsies were negative for SSC. The patient underwent radiation therapy for PLGA and unknown primary SSC antigen. Conclusion Synchronous tumors of the head and neck are seldom reported and they present unique treatment challenges. This case report discusses the diagnosis, management, and unique nature of two malignant synchronous noncollision tumors in the head and neck. How to cite this article Fisher AD, McClure SA, Franco J. A Report on Synchronous Polymorphous Low-grade Adenocarcinoma and Unknown Primary Squamous Cell Carcinoma. Int J Head Neck Surg 2015;6(4):181-186.

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Giant melanotic neuroectodermal tumor of infancy (melanotic progonoma) of the head and neck: report of a malignant case

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.11.peds16509 ◽

2017 ◽

Vol 19 (5) ◽

pp. 538-545 ◽

Cited By ~ 7

Author(s):

Giancarlo Nicosia ◽

Pietro Spennato ◽

Ferdinando Aliberti ◽

Daniele Cascone ◽

Lucia Quaglietta ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Lymph Nodes ◽

Neuroectodermal Tumor ◽

Surgical Removal ◽

Radical Excision ◽

Cervical Lymph Nodes ◽

Advanced Tumor ◽

Malignant Case ◽

Long Time ◽

The Right

Melanotic neuroectodermal tumor of infancy is a rare congenital pigmented neoplasm of neural crest origin, locally aggressive, growing rapidly and developing during the 1st year of life. It most commonly arises from the maxilla, cranial vault, and mandible. Occasionally, it exhibits malignant behavior with local lymph nodes involvement. Cases misdiagnosed and left untreated for a long time can present challenges due to the tumor mass and infiltration. In these cases, adjuvant chemotherapy can be extremely helpful before radical excision.Authors of this report describe a 4-year-old boy from a developing country who was referred to their hospital with an ulcerated bulging lesion in the midline/right parietooccipital region, extending to the right laterocervical and parotid regions, resulting in significant craniofacial deformation. Magnetic resonance imaging of the brain revealed a highly enhancing tumor with intracranial and extracranial development extending mainly at the level of the right parietooccipital region, with lytic and hypertrophic alterations of the skull. The patient was managed with neoadjuvant and adjuvant chemotherapy and radically resective surgery on metastatic lymph nodes and the primary tumor of the skull. Scheduled radiotherapy was not performed, according to the parents' wishes. The patient returned to his native country where the lesion recurred, and he ultimately died approximately 10 months after the end of the treatment.The literature indicates that tumor removal alone has been the treatment of choice in most isolated cases, but in cases of highly advanced tumor with involvement of the skull and cervical lymph nodes, it is preferable to proceed with preoperative chemotherapy with the aim of reducing the tumor volume, allowing better technical conditions for complete surgical removal, and decreasing the risk of local recurrence or metastasis.

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