1/36. Axillary nodal metastases in head and neck cancer.BACKGROUND: Axillary node metastasis is an uncommon occurrence in squamous carcinoma of the upper aerodigestive tract. methods: The tumor registry of The Johns Hopkins University Department of otolaryngology-head and neck Surgery contained four cases of metastasis to the axilla from head and neck primary sites. A retrospective review of these cases was performed. RESULTS: Each patient had been initially treated for cancer years earlier including surgery and radiation to the neck. A recurrent cancer or a new primary then developed in the upper aerodigestive tract prior to the development of the axillary metastases. CONCLUSIONS: The common course of disease in these patients suggests that alteration of the lymphatic anatomy by previous treatment may have caused a new pattern of metastatic spread upon reseeding from the mucosa, resulting in the axillary metastases. Routine surveillance of the axillae by physical examination and/or computerized imaging in at risk patients may permit the early diagnosis of axillary metastases.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/36. 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 = 2keywords = physical examination, physical (Clic here for more details about this article) |
3/36. osteoradionecrosis of the cervical vertebrae and occipital bone: a case report and brief review of the literature.osteoradionecrosis (ORN) is a common complication of radiation therapy. We present the first case reported in the literature of ORN involving the first and second cervical vertebrae and occipital bone in a patient who was treated with surgery and radiation therapy 9 years prior for a TxN3M0 squamous cell carcinoma of the left neck arising from an unknown primary origin. A brief review of the pathophysiology and treatment of this pathological process is also presented. Although the mandible is the most commonly affected site in the head and neck, ORN may develop in an unusual location without any preceding trauma and display an insidious but rapidly progressive course. The pathophysiology of ORN is believed to be a complex metabolic and homeostatic deficiency created by radiation-induced cellular injury and fibrosis, which is characterized by the formation of hypoxic, hypovascular, and hypocellular tissue. The irradiated bone loses its capability to increase the metabolic requirements and nutrient supply required to replace normal collagen and cellular components lost through routine wear. This results in tissue breakdown and the formation of a chronic nonhealing wound. infection plays only a contaminant role, with trauma being a possible initiating factor. Diagnosis of ORN begins with a complete physical examination, including fiberoptic examination and biopsy of any suspicious lesion to eliminate the possibility of recurrent tumor. Treatment of ORN commonly requires the debridement of necrotic bone and hyperbaric oxygen therapy. The head and neck surgeon must possess a high degree of suspicion to promptly diagnose ORN and initiate early treatment. Because of similarities in clinical presentation, the most important step in the initial management of suspected ORN is to eliminate the possibility of tumor recurrence or a new primary.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/36. Ossifying lipoma independent of bone tissue.A 46-year-old Japanese male was referred to a local hospital because of a firm, nontender mass on his neck. On physical examination, the tumor was soft, well demarcated, 3 x 2 cm in size and located in the submucosal region. It was entirely separate from the vertebrae. The resected tumor was shown to be a lipoma with focal ossification. Ossifying lipomas are rare, and the cases which are independent of bone even more so. A literature review revealed that ossifying lipoma independent of bone tissue has been reported in only 8 cases, and, interestingly, all of them occurred in the head and neck region.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/36. rhabdomyosarcoma presenting as an anterior cervical mass in an adult: report of a case.We report herein the case of a 61-year-old man who was referred to our hospital for treatment of a rapidly growing tumor in the right anterior cervical region. A 13 x 14 x 15 cm mass was palpated on physical examination. Computed tomography (CT) findings indicated a thyroid tumor, but cytology results suggested rhabdomyosarcoma. A tumor, measuring 9.3 x 7.2 x 5.2 cm and weighing 220 g, was resected and histopathological examination confirmed a diagnosis of rhabdomyosarcoma. Cervical rhabdomyosarcoma is rarely found in adults.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/36. Cervical manifestation of blastomycosis.blastomycosis is a common systemic fungal infection in which the physical and radiographic findings appear far more serious than the subjective signs and symptoms. Although blastomycosis of the head and neck is often difficult to diagnose, clues in the patient's history and a few laboratory tests can establish the diagnosis. Involvement of the skin and soft tissues provides an unusual opportunity for direct access to the organism for culture and pathologic diagnosis. We present a case of blastomycosis presenting in a single abscessed cervical lymph node. The diagnosis was established by fine-needle aspiration of the cervical mass. The primary lung disease was confirmed by chest radiography and computed tomography. The clinical and pathologic features of the disease are discussed. [editorial comment: Pulmonary blastomycosis may present with cervical adenopathy. This article demonstrates the potential value of fine needle aspiration in establishing this diagnosis.]- - - - - - - - - - ranking = 0.096810428102055keywords = physical (Clic here for more details about this article) |
7/36. A case of head and neck kaposiform hemangioendothelioma simulating a malignancy on imaging.Kaposiform hemangioendothelioma (KH) is an endothelial-derived spindle cell neoplasm often associated with kasabach-merritt syndrome. Most cases arise in infancy and childhood and are soft-tissue tumors. The tumor displays an appearance between capillary hemangioma and Kaposi's sarcoma. We report a case of KH in a 1-year-old girl involving a mass that showed abnormal enhancement of soft tissue superficial to the right temporal bone with partial destruction of the temporal bone, the temporomandibular joint, mandibular condyle, and occipital bone. The physical finding of a discolored mass led clinicians to consider a hemangiomatous lesion, whereas the radiological picture suggested a more aggressive diagnosis of rhabdomyosarcoma and aggressive fibromatosis.- - - - - - - - - - ranking = 0.096810428102055keywords = physical (Clic here for more details about this article) |
8/36. Spontaneous internal jugular vein thrombosis associated with distant malignancies.Internal jugular vein (IJV) thrombosis is an extremely rare vascular disease that is easily overlooked or misdiagnosed. It is usually secondary to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Associated malignancies, either known or occult, are also uncommon and not well documented in the etiology of IJV thrombosis. A previously healthy, 48-year-old man presented to our Ear, nose and Throat (ENT) Department with pain and swelling of the right side of the neck, which had been going on for a period of 9 days, with the absence of any other ENT symptoms. Examination of his neck showed swelling and tenderness along the anterior border of the right sternocleidomastoid muscle. An ultrasound scan of the neck confirmed right IJV thrombosis. Further investigation to determine the cause for the thrombosis revealed two coincidental malignancies: prostate and lung. This shows that every patient with spontaneous thrombophlebitis must undergo a careful history, a complete physical examination and a thorough investigation to avoid missing or delaying the diagnosis of a hidden malignancy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/36. Obstructive sleep apnea in head and neck cancer patients post treatment ... something to consider?Obstructive sleep apnea (OSA) occurs due to enlarged tissue such as tonsils, base of tongue or palate, pharyngeal space narrowing, or decreased muscle tone of the pharyngeal dilator muscles. Treatments for head and neck cancer may cause physical changes resulting in OSA. Based on recent anecdotal experience and limited research available looking at the incidence of OSA in post treatment head and neck cancer patients, assessment for signs and symptoms of OSA by otorhinolaryngology nurses seems warranted. Prompt diagnosis and treatment of OSA in the patient with head and neck cancer may significantly improve the person's health and quality of life.- - - - - - - - - - ranking = 0.096810428102055keywords = physical (Clic here for more details about this article) |
10/36. 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 = physical examination, physical (Clic here for more details about this article) |
| | Next -> |