1/19. The role of positron emission tomography in occult primary head and neck cancers.PURPOSE: To evaluate the utility of positron emission tomography (PET) fluorodeoxyglucose (FDG) imaging in the workup of unknown primary head and neck tumors. methods: Fourteen patients with squamous cell carcinoma of cervical lymph node metastasis of unknown primary origin (clinical stage N2-N3) were studied prospectively. The patients underwent conventional workup, including physical examination, computed tomography, and random biopsies of the potentially suspected sites. If no primary site was found, 8 to 13 mCi of FDG was given intravenously, and whole-body scans with standardized uptake values were obtained. The results of FDG-PET imaging were compared with clinical, CT, and histopathologic findings. To eliminate bias, PET scans were reviewed by nuclear medicine physicians who had no previous knowledge of the other findings. RESULTS: PET identified the location of primary tumor in three patients: lung hilum, base of tongue, and pyriform sinus. These lesions were pathologically confirmed. All these primary sites were not visualized on CT or physical examination, except for a pyriform sinus lesion, which was seen on CT, but initial biopsy result was negative. In one patient, the initial PET did not identify a primary tumor, but a nasopharyngeal carcinoma was identified in post-radiation therapy follow-up PET. In the remaining nine patients, a primary lesion was never found. All cervical lymph nodes detected by CT were identified by PET. DISCUSSION: A previously unknown primary tumor can be identified with FDG-PET in about 21% of the patients in our prospective series. PET can be of value in guiding endoscopic biopsies for histologic diagnosis and treatment options.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/19. Ethical considerations in the treatment of head and neck cancer.BACKGROUND: The second half of the 20th century saw not only important developments in medical science and technology, but also a rapid growth in the application of biomedical ethics in medical decision making. Withdrawal of treatment, allowing to die, informed consent, and patient autonomy are concerns that now comprise a part of the overall medical treatment, particularly in patients with head and neck cancers. methods: The author discusses ethical issues relating to disfigurement/dysfunction in head and neck cancer patients and examines the aspects of "principlism": autonomy, nonmaleficence, beneficence, and justice. Two case reports are presented to illustrate the ethical challenges that may confront physicians who treat head and neck cancer patients. RESULTS: head and neck oncology generates unique problems relating to disfigurement and dysfunction. An algorithm that considers the patient's medical good and greater good, as well as the goods of others, can assist in arriving at appropriate ethical decisions. CONCLUSIONS: Bioethical decision making requires the integration of virtues with principles, followed by the application of these standards to each patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/19. Case report of metastatic carcinoid tumor to the neck.Since their origianl description in 1838 carcinoid tumors have interested physicians. This case represents another unusual presents another unusual presentation of a carcinoid tumor in which the cervical area has rarely been reported. In addition, it demonstrates the elusiveness of the tumor despite exhaustive diagnostic studies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/19. Malignant fibrous histiocytoma of the head and neck after radiation for squamous cell carcinoma.A 60-year-old man presented with malignant fibrous histiocytoma of the oropharynx. The mass extended into the nasopharynx and larynx and caused severe upper airway obstruction that required emergency tracheotomy. Ten years earlier, he had undergone a right partial glossectomy and segmental mandibulectomy for squamous cell carcinoma of the right tongue base,followed by 50 Gy of radiation delivered over 33 sessions. The tumor was so aggressive that changes in its volume were visually distinguishable during physical examination over a 2-week hospital stay. Histologic evaluation revealed 7 mitotic figures per high-power field. Although radiation-induced malignant fibrous histiocytoma is rare in the head and neck, the recent medical literature indicates that its incidence is rising. This rise has been attributed to the increased effectiveness of head and neck cancer therapy, which results in prolonging patients' survival and, hence, their risk of subsequent disease. Because malignant fibrous histiocytoma is a late complication of radiation therapy, appearing on average 10 years following treatment, it is important that physicians who treat head and neck cancer monitor these patients over the long term and remain alert for its appearance, even despite the apparent "cure" of their original neoplasm.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/19. Calcifying fibrous pseudotumor of the neck: diagnostic challenges of a rare benign lesion.neck masses, frequently encountered by physicians, comprise a vast range of diagnoses, with malignancy being the greatest concern. Calcifying fibrous pseudotumor (CFP) is a rare lesion with unknown pathogenesis, characterized pathologically by a predominance of abundant hyalinized collagenous tissue with focal lymphoplasmacytic infiltrate and psammomatous or dystrophic calcifications. We present the case of a 29-year-old woman who presented with a 4-cm left neck mass, accompanied by constitutional symptoms of vague weakness and lethargy. After the lesion failed to respond to a course of antibiotic therapy, fine-needle aspiration was performed, the pathology of which was indeterminate. The concern was that the lesion was a lymphoproliferative disorder-further workup was performed. CT of the chest, abdomen, and pelvis revealed no evidence of adenopathy or neoplasms. Subsequently, an incisional biopsy was performed, suggesting a diagnosis of CFP. magnetic resonance imaging with contrast, performed to delineate the anatomy, revealed the lesion in the left neck, deep to the left clavicle, that extended superiorly into the supraclavicular fossa. Complete surgical removal of the lesion was successfully performed, with immunophenotyping confirming the initial diagnosis of CFP. We present a case report of cervical CFP, discuss the approach to neck masses, and review the recent literature on this rare, benign entity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/19. The reasons for discrepancies in target volume delineation : a SASRO study on head-and-neck and prostate cancers.PURPOSE: To understand the reasons for differences in the delineation of target volumes between physicians. MATERIAL AND methods: 18 Swiss radiooncology centers were invited to delineate volumes for one prostate and one head-and-neck case. In addition, a questionnaire was sent to evaluate the differences in the volume definition (GTV [gross tumor volume], CTV [clinical target volume], PTV [planning target volume]), the various estimated margins, and the nodes at risk. Coherence between drawn and stated margins by centers was calculated. The questionnaire also included a nonspecific series of questions regarding planning methods in each institution. RESULTS: Fairly large differences in the drawn volumes were seen between the centers in both cases and also in the definition of volumes. Correlation between drawn and stated margins was fair in the prostate case and poor in the head-and-neck case. The questionnaire revealed important differences in the planning methods between centers. CONCLUSION: These large differences could be explained by (1) a variable knowledge/interpretation of ICRU definitions, (2) variable interpretations of the potential microscopic extent, (3) difficulties in GTV identification, (4) differences in the concept, and (5) incoherence between theory (i.e., stated margins) and practice (i.e., drawn margins).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/19. Inappropriate antidiuretic hormone complicating histiocytic lymphoma.The syndrome of inappropriate antidiuretic hormone (IADH) often causes the hyponatremia that may be seen in patients with malignant disorders. Most physicians correctly associate IADH with small cell carcinoma of the lung. We describe two patients in whom IADH was caused by histiocytic lymphoma. One patient was thought to have small cell carcinoma of the lung on the basis of marrow infiltration and the IADH. When the proper diagnosis was made and therapy instituted, both patients responded, with rapid resolution of their disease and the IADH. The identification of the neoplasm that produces the IADH is important, since histiocytic lymphoma may mimic small cell carcinoma of the lung, yet may be very responsive with newer treatment regimens.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/19. Malignant lymphomas of the oral soft tissues.Two cases have been presented in which a malignant lymphocytic tumor was found in the oral soft tissues. The first was a "histiocytic lymphoma" that appeared as a rapidly growing, ulcerative lesion. This tumor was the initial presentation of disease and may be considered a primary lesion. The second was a "poorly differentiated lymphocytic lymphoma" which formed a mass in the mental area. In that case, the tumor was associated with widespread disease. Both of these lesions had previously been diagnosed by physicians as inflammatory processes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/19. Ethical dilemmas in head and neck cancer.Ethical dilemmas in head and neck cancer daily confront physicians, patients, families, and society at large. For every situation there are potential benefits and real burdens, as well as risks. There are no "right" answers for any given situation, but there are processes for assisting the primary decision makers involved in reaching meaningful and appropriate decisions. This paper asks some pertinent ethical questions and suggests some ways of responding to the issues.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/19. Lymphangiomas of the larynx in infants and children. A survey of pediatric lymphangioma.Lymphangiomas are uncommon benign congenital lymphatic tumors of childhood. They are found in all parts of the body structure, but rarely occur in the larynx. This paper reviews charts of 160 patients with cystic hygroma (lymphangiomata) of whom ten had extensive involvement of the larynx. A benign but nevertheless challenging tumor, its treatment demands the patience and skill of the surgeon. The lesion is more common in the white patient, and 40% appear in the newborn. Fifty percent present by the end of the first year of life, and 75% by the end of the second. The onset is uncommon in the older child and a rare occurrence in the adult. The treatment of lymphangiomata is surgical excision, and is more difficult when in the larynx. Laser surgery has been most helpful when the lesion is in the laryngeal complex. Considering the extreme difficulties which lymphangioma present to the child and to the physician, the ultimate results of all forms of conservative surgical therapy can be rewarding. Excessive or radical surgery will not necessarily guarantee complete elimination of disease and may be harmful.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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