Parotid Salivary Gland Extramedullary Plasmacytoma with Local Lymph Node Metastasis in a Dog

ABSTRACT A 12 yr old spayed female mixed-breed dog presented for evaluation of a recurrent soft-tissue sarcoma. On physical examination, a firm mass was palpated ventral to the left ramus of the mandible. A fine-needle aspirate of the mass was suggestive of a round-cell neoplasm. A complete blood count, serum biochemical profile, and an abdominal ultrasound with liver and splenic aspirates were performed, and no clinically relevant abnormalities were identified. Advanced imaging of the skull identified an enlarged parotid salivary gland and an enlarged ipsilateral medial retropharyngeal lymph node. The medial retropharyngeal lymph node was sampled via fine-needle aspiration, and a round-cell population similar to what was present in the mass was identified. An incisional biopsy was performed under general anesthesia, which yielded a diagnosis of salivary gland extramedullary plasmacytoma, confirmed with immunohistochemistry (MUM-1). The parotid salivary gland and medial retropharyngeal lymph node were then surgically excised, and metastasis to the lymph node was confirmed by histopathology. The dog remained alive for 685 days after surgery until she was euthanized for hindlimb paresis of undetermined cause.

Multiple spillovers and onward transmission of SARS-Cov-2 in free-living and captive White-tailed deer (Odocoileus virginianus)

Many animal species are susceptible to SARS-CoV-2 and could potentially act as reservoirs, yet transmission in non-human free-living animals has not been documented. White-tailed deer (Odocoileus virginianus), the predominant cervid in North America, are susceptible to SARS-CoV-2 infection, and experimentally infected fawns transmit the virus to other captive deer. To test the hypothesis that SARS-CoV-2 may be circulating in deer, we evaluated 283 retropharyngeal lymph node (RPLN) samples collected from 151 free-living and 132 captive deer in Iowa from April 2020 through December of 2020 for the presence of SARS-CoV-2 RNA. Ninety-four of the 283 deer (33.2%; 95% CI: 28, 38.9) samples were positive for SARS-CoV-2 RNA as assessed by RT-PCR. Notably, between Nov 23, 2020, and January 10, 2021, 80 of 97 (82.5%; 95% CI 73.7, 88.8) RPLN samples had detectable SARS-CoV-2 RNA by RT-PCR. Whole genome sequencing of the 94 positive RPLN samples identified 12 SARS-CoV-2 lineages, with B.1.2 (n = 51; 54.5%), and B.1.311 (n = 19; 20%) accounting for ~75% of all samples. The geographic distribution and nesting of clusters of deer and human lineages strongly suggest multiple zooanthroponotic spillover events and deer-to-deer transmission. The discovery of sylvatic and enzootic SARS-CoV-2 transmission in deer has important implications for the ecology and long-term persistence, as well as the potential for spillover to other animals and spillback into humans. These findings highlight an urgent need for a robust and proactive One Health approach to obtaining a better understanding of the ecology and evolution of SARS-CoV-2.

A retropharyngealis nyirokcsomóáttétek klinikai jelentősége

Összefoglaló. A retropharyngealis nyirokcsomóáttétek incidenciája a primer fej-nyaki daganat lokalizációjától függ. Leggyakrabban az előrehaladott vagy recidív nasopharynx-carcinomák esetén fordul elő, de III–IV. stádiumú oro- és hypopharynxtumorok esetén is megjelenhetnek. Non-nasopharyngealis primer tumoroknál a manifesztációjuk kedvezőtlen prognosztikai faktornak tekinthető, melynek hátterében a diagnosztikus nehézség miatti késői detektálás, a kifejezetten nehéz sebészi eltávolíthatóság, valamint az agresszív biológiai viselkedés állhat. Az esetismertetésünkben bemutatásra kerülő, 58 éves betegünknél bal oldali elülső szájfenéki primer tumort diagnosztizáltunk azonos oldali nyaki és retropharyngealis nyirokcsomó-metastasissal, mely a nemzetközi irodalom alapján extrém raritás, incidenciája kevesebb mint 1%. A retropharyngealis nyirokcsomók diagnosztikájában a lokalizáció miatt a képalkotóknak jut hangsúlyosabb szerep. Elhelyezkedésük nemcsak diagnosztikus, hanem sebésztechnikai kihívást is jelentenek az életfontosságú anatómiai képletek közelsége, illetve a szűk feltárási viszonyok miatt. Ilyenformán ezek a műtétek csak intenzív osztályos háttérrel és kellő jártassággal rendelkező centrumokban végezhetők. Az alapvetően rossz prognózist a korai diagnózis és a multimodális terápia kedvezően befolyásolja. Esetünkben a komplex kezeléssel (sebészi terápia és posztoperatív radiokemoterápia) sikerült lokoregionális tumormentességet elérni, és ezzel a teljes és a betegségmentes túlélési időt növelni. Orv Hetil. 2021; 162(25): 997–1003. Summary. The incidence of retropharyngeal lymph node metastasis depends on the localization of the primary head and neck cancer. Involved nodes are seen most commonly in cases of advanced or recurrent nasopharyngeal carcinoma, however, they might occur with stage III–IV oro- and hypopharyngeal tumours. The involvement of retropharyngeal lymph nodes has been associated with poor outcome of non-nasopharyngeal primary tumours, which might be explained by the delayed diagnosis, the difficult surgical procedure in the retropharyngeal space, and the aggressive nature of the disease. Here we present the case of a 58-year-old patient with an anterior oral cavity tumour on the left side with ipsilateral cervical lymph node and retropharyngeal lymph node metastases, which has been noted an extreme rarity in the literature with less than 1% incidence. Due to the localization of the retropharyngeal lymph nodes, the detection is based on imaging modalities. It represents a challenge for diagnosis and surgical treatment due to the close proximity of vital anatomical structures. Accordingly, these operations should only be performed in specialist surgical centres with intensive care units. The early diagnosis and the multimodality treatment might have a positive effect on the poor prognosis. In our case, we managed to achieve locoregional disease-free status with the complex treatment (surgical therapy and postoperative radiochemotherapy) and increase the overall and the disease-free survival. Orv Hetil. 2021; 162(25): 997–1003.

Retropharyngeal lymph node metastasis on N stage of nasopharyngeal carcinoma

Purposes To evaluate retropharyngeal lymph node metastasis on N stage of nasopharyngeal carcinoma (NPC). Methods NPC patients were extracted from the Surveillance, Epidemiology, and End Results database between 2004 and 2016. Pathologically confirmed patients with complete data of retropharyngeal lymph node metastasis were investigated. The included patients were divided into N1a and N1b groups. Overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan–Meier method and propensity score matching (PSM) analyses. Results This retrospective cohort study examined 759 patients: 70 who were stage N1a and 689 who were stage N1b. Before PSM, N1a group was associated with similar 5-year OS (77.7% vs. 72.4%; P = 0.15) and CSS (85.6% vs. 79.9%; P = 0.09) compared to N1b group. After PSM, a similar OS (75.0% vs. 60.7%; P = 0.12) was found between the radiotherapy and chemoradiotherapy groups. However, N1a group showed a better 5-year CSS (83.8% vs. 71.1%; P = 0.04) compared to N1b group. Stage N1b was an independent risk prognostic factor for CSS (hazard ratio = 2.54, 95% confidence interval: 1.02–6.34; P = 0.04). Conclusions OS was not different between N1a and N1b groups. Retropharyngeal lymph node metastasis defined as stage N1 of the 8th edition American Joint Committee on Cancer staging system is reasonable.

Retropharyngeal Lymph Node Metastasis Diagnosed by Magnetic Resonance Imaging in Hypopharyngeal Carcinoma: A Retrospective Analysis From Chinese Multi-Center Data

BackgroundTo assess the prevalence, risk factors and prognostic significance of retropharyngeal lymph node (RPLN) metastasis diagnosed by magnetic resonance imaging (MRI) in patients with hypopharyngeal squamous cell carcinoma (HPSCC).Methods259 patients from three cancer institutions in China from Jan 2010 to Dec 2018 were analyzed, retrospectively. All the patients had been given pre-treatment magnetic resonance imaging (MRI) of head and neck and were then treated with definitive radiotherapy with or without chemotherapy. Pretreatment diagnostic MRIs were reviewed by a dedicated head and neck radiologist, for the presence or absence of radiographically positive RPLN, cervical LN and tumor invasion.Demographic variables were analysed by descriptive statistics using SPSS 20.0. Predictors of the presence of RPLN and its prognostic significance were examined.ResultsRPLN metastasis was discovered in 44 patients (17%). Logistic analysis showed that posterior pharyngeal wall (PPW) primary tumor; PPW invasion; N2-3; multiple cervical lymph node (LN) involvement (>2 LNs) were associated with RPLN metastasis, with metastasis rates 37%, 30%, 31% and 33% respectively. Patients with RPLN metastasis had a significantly reduced 5-year overall survival (OS) and disease-free survival (DFS) compared to the non-RPLN metastasis group (OS 28% vs. 48%, p=0.001; DFS 25% vs. 41%, p=0.040).ConclusionsRPLN metastasis was not uncommon in HPSCC patients. Risk factors were: PPW primary tumor, PPW invasion and cervical LN status. RPLN metastasis is a poor prognosticator for survival.

Case Report: Use of PET/CT to Guide Treatment in a Cat With Presentation Consistent With Hodgkin's-Like Lymphoma

An 8-year-old male neutered Domestic Long Hair cat was presented for a cervical swelling that was suspected to be an enlarged left retropharyngeal lymph node. In the absence of other lymphadenopathy, this was initially suspected to be Hodgkin's-like lymphoma. A positron emission tomography–computed tomography (PET/CT) scan was performed using 2-deoxy-2-[18F]-fluorodeoxyglucose (18F-FDG) to assess for evidence of disease in other locations to guide treatment. Multifocal increased radiopharmaceutical uptake was identified, indicating disease in multiple organs. High-grade lymphoma was confirmed on tissue biopsy. As such, systemic cytotoxic chemotherapy was recommended instead of lymph node extirpation surgery. The cat received a modified CHOP chemotherapy protocol and attained a temporary partial remission. After 2 months of treatment, the cat stopped responding to chemotherapy and was eventually euthanized due to a relapse of disease and decreased quality of life. This case describes the utility of PET/CT to guide treatment in a cat with a presentation consistent with Hodgkin's-like lymphoma.

Detection of chronic wasting disease in mule and white-tailed deer by RT-QuIC analysis of outer ear

Efforts to contain the spread of chronic wasting disease (CWD), a fatal, contagious prion disease of cervids, would be aided by the availability of additional diagnostic tools. RT-QuIC assays allow ultrasensitive detection of prion seeds in a wide variety of cervid tissues, fluids and excreta. The best documented antemortem diagnostic test involving RT-QuIC analysis targets lymphoid tissue in rectal biopsies. Here we have tested a more easily accessed specimen, ear pinna punches, using an improved RT-QuIC assay involving iron oxide magnetic extraction to detect CWD infections in asymptomatic mule and white-tailed deer. Comparison of multiple parts of the ear pinna indicated that a central punch spanning the auricular nerve provided the most consistent detection of CWD infection. When compared to results obtained from gold-standard retropharyngeal lymph node specimens, our RT-QuIC analyses of ear samples provided apparent diagnostic sensitivity (81%) and specificity (91%) that rivaled, or improved upon, those observed in previous analyses of rectal biopsies using RT-QuIC. These results provide evidence that RT-QuIC analysis of ear pinna punches may be a useful approach to detecting CWD infections in cervids.