Syncope caused by lymphomatous encasement of the internal carotid artery

We present a case of a 77-year-old man who reported 5 months of syncopal episodes. He was found to have diffuse large B-cell lymphoma encasing the left internal carotid artery but not impeding blood flow. The syncopal episodes resolved after his first cycle of chemotherapy. Recurrent syncope in non-cardiac lymphomas and other head and neck masses is exceedingly rare and may be due to reflex syncope prompted by carotid baroreceptor activation. There are 11 previously described cases of recurrent syncope associated with non-cardiac lymphoma. In all cases, lymphadenopathy abutting the carotid artery was present and the syncopal episodes resolved with treatment. Our case illustrates that malignancy should be considered in patients with unexplained recurrent syncope.

Pediatric Head and Neck Malignancies

Head and neck malignancies are a part of the differential diagnosis of head and neck masses seen in the pediatric age group. It is critical to make prompt diagnosis and employ proper treatment. We will review the most common malignant pathologies as well as their specific clinical presentations and management. Centers that are able to provide multidisciplinary care for pediatric patients with head and neck pathology can help achieve the best outcomes.

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications

Objective: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. Materials and Methods: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. Results: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. Conclusion: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

Endoscopically-Assisted Scar-Free Midline Neck Mass Excision

Traditional open surgery is indicated for the treatment of selected tumor subsites in the head and neck. However, it can cause major cosmetic problems and functional pathologies. The endoscopically-assisted transoral approach is increasingly preferred in some surgical fields due to its superior cosmetic and functional outcomes. Nonetheless, endoscopically-assisted transoral approach is not yet standard in the head and neck due to their anatomical complexity. The transoral surgical approach has been used for head and neck masses since the 1960s, and its application continues to evolve with changing disease conditions and recent innovations in surgical instruments. The potential for wide application of transoral surgery continues to be investigated, with a focus on minimizing occurrence of the complications. This review presents details of the surgical procedure and postoperative clinical outcomes, as well as endoscopically-assisted scar-free techniques for the resection of midline neck masses.

Oncosuppressor-Mutated Cell-Based Diagnostic Platform for Liquid Biopsy Diagnoses Benign Head and Neck Masses and Predicts Malignancy in Thyroid Nodules: Results from a Consecutive Cohort of Patients

<b><i>Background:</i></b> We reported that a novel oncosuppressor-mutated cell (OMC)-based platform has the potential for early cancer detection in healthy individuals and for identification of cancer patients at risk of developing metachronous metastases. <b><i>Objective:</i></b> Herein, we sought to determine the diagnostic accuracy of this novel OMC-based platform in a consecutive cohort of patients operated for suspicious head and neck masses. <b><i>Methods:</i></b> OMCs (<i>BRCA1</i>-deficient fibroblasts) were exposed to blood serum from patients with head and neck nodules before surgical removal. These cells were analyzed for their proliferation and survival. Treated OMCs were inoculated subcutaneously in NOD/SCID mice, and tumor growth was monitored over time. <b><i>Results:</i></b> OMCs exposed to serum from patients with malignant lesions displayed increased proliferation compared to those exposed to serum from patients with benign lesions. Only OMCs exposed to serum from patients diagnosed with malignant thyroid neoplasia generated a cancerous mass. The sensitivity of the test was 92%, with only 1 false negative out of 34 patients. Immunohistochemical staining showed that the cancerous masses were poorly differentiated adenocarcinomas with high proliferative index. <b><i>Conclusions:</i></b> These data show that liquid biopsy combined with an OMC-based in vivo platform has the potential to diagnose benign head and neck masses and predict whether a thyroid nodule is malignant. These results strengthen the concept that OMCs can be used to detect circulating malignant factors in cancer patients.

Fine Needle Aspiration Cytology (FNAC) as a Fast and Cheap Tool in Dermatologic Routine

FNAC is commonly used in endocrinology, otorhinolaryngology and other areas, especially for evaluation of thyroid nodules, head and neck masses, enlarged lymph nodes and salivary gland abnormalities. Although FNAC is not a common practice in dermatology routine, in this prospective study, ninety-eight patients presenting with palpable lesions were submitted to FNAC and biopsy at the same time. The majority of cases (82 patients) were diagnosed as basal cell carcinoma on cytology, and had 100% of agreement with histopathology. Three cases presented as insufficient material in FNAC and all of them were diagnosed as superficial basal cell carcinoma in histopathology. All cases of squamous cell carcinoma (6 patients) were diagnosed accurately by FNAC. Two cases in our series were diagnosed as keratoacanthoma and due to the clinical correlation with cytopathology the report addressed this compatibility in a note; without the clinic it would be impossible to infer this diagnosis. All four cases of molluscum contagiosum showed characteristic cytopathological aspects and also had 100% of agreement with histopathology. The main potential use appears to be fastest results and confirmation of clinical diagnosis of basal cell carcinoma and squamous cell carcinoma to allow immediate referral for surgery. FNAC could also prove itself useful when the clinical diagnosis of molluscum contagiosum is among the clinical hypotheses, allowing to confirm it by viewing the characteristic intracytoplasmic inclusion bodies (molluscum bodies, or Henderson-Paterson bodies). The number of repeat out-patient clinic attendances could thus be reduced and valuable time saved on biopsy lists.

Our Experience in Treating a Rare Clinical Case Angiomyomatous Hamartomas of Head and Neck Region; Case Report

Angiomyomatous hamartoma of head and neck region is very are disease, of unknown etiology and more often than not it can be misdiagnosed preoperatively. Materials and Methods: In a study we present a case of angiomyomatous hamartoma in the carotid triangle, a site where a tumor has an invasion to external carotid artery, treatment carried out by surgical excision, after histological examination, the final diagnosis was made. The patient was under observation for 3 years, there were no relapses. Conclusion: The diagnosis of angiomyomatous hamartoma is based on histologic examination. Although this entity is rare, we believe that head and neck surgeons should include it in the differential diagnosis of head and neck masses.