unusal cases of head and neck.pptx unusal cases of head and neck unusal cases of head and neck

unusal cases of head and neck
unusal cases of head and neck

1. Unusual cases of head and neck oncology -our institutional experience Dr. Simran p armar Pramukhswami medical college,karamsad , anand

2. Introduction : Early diagnosis and prompt treatment is required to eliminate the lesion. Histopathology forms the basis of accurate diagnosis. A presumptive diagnosis is often made using advanced imaging and Computed tomography (CT) and Magnetic resonance imaging (MRI). The variation in the histopathological types and grades of the lesions, particularly malignancies has led to necessity in studying the clinical and pathological aspects. Understanding the exact nature of the lesion will help in strengthening the diagnosis and management.

3. Aim : The aim of this study is to investigate and analyze unusual cases of head and neck cancer, with a focus on understanding their incidence, clinical characteristics, treatment outcomes, and potential underlying factors contributing to their rarity and provide valuable insights into the diagnosis, management, and prognosis of these uncommon cases, ultimately aiming to improve patient care and outcomes. To study the clinicopathological profile of patient.

4. Case 1 A 24 year old male patient came to ent opd with C/O swelling over left side of parotid region since 5-6 months. O/C/O right frontotemperoparietal (FTP) decompressive craniotomy under GA ( 25/01/2022 )
O/C/O right FTP cranioplasty under GA ( 13/05/2022) USG local pa rt : Well defined round to oval shaped cystic area with few internal septation and hyperexhoic area within is noted over the left parotid region with no internal vascularity. FNAC: category IVa benign lesion of left parotid region

5. MRI NECK : Solid cystic lesion with central solid componet is noted in left parotid region
Lesion infiltrating left parotid and left masseter muscle
Multiple enlarged enhancing lymph nodes in la, B/L Ib, B/L lla, B/L IIb, B/L III, B/L Vb

6. Pre operative clinical photos

7. Inta operative photos

8. post op scar photo Surgical management Left superficial parotidectomy was done. Histopathological examination: 1. Mammary analogue secretory carcinoma 2. Mucoepidermoid carcinoma (T2N0)

9. Case 2 A 16 year old male patient was presented to ENT opd with complaints of Difficulty in swallowing since 8 months, Nasal regurgitation since 8 months Swelling over right submandibular region since 8-9 months Swelling present over right tonsillar area since 8 months Change in voice since 4 months (Hot potato voice)

10. Local examination Oral Cavity: A right Lateral oropharyngeal wall including tonsil along with anterior pillar were pushed medially, also posterolateral wall of the oropharynx showed bulge-right upto vallecula .

11. Investigations Large, well difened lesion 5x6x8 cm seen involving right side along right carotid space/ parapharyngeal region splaying right internal carotid artery and right external carotid artery giving LYRE sign. Laterally lesion displaces carotid artery and extends into right parapharyngeal space causing mass effect on right naso-oropharyngeal mucos

12. Anteriorly causing mass effect over right tonsillolingual sulcus , base of tongue, epiglottis and right valleula.
Posteriorly displaces right internal carotid abutting right paravertebral and right paraspinal region.
Suggests possibility of large paraganglioma/ ? Vagal schwannoma. Surgical management: Right transcervical excision of mass and reconstruction done with right side sternal head of sternocleidomaatoid muscle.

13. HPR report The histological findings suggestive of Paraganglioma Alveolar soft part sarcoma Post op.photo

14. Case 3 A 45 year old female came to ent opd with Complaint of right side nasal obstruction since 1 year and mass protruding from right nostril since 4 months [Image XII (A )]. CT scan of paranasal sinuses shows polypoidal lesion involving middle and inferior meatus. It causes erosion of the middle and inferior turbinates . [Image XII (B,C ) Endoscopic excision of mass done. Histopathological examination of specimen revealed adenoid cystic carcinoma. Image XII (D) showing specimen of adenoid cystic carcinoma .

15. Case 4 A16 yr old male came with the complain of rightside nasal blockage and right, eye proptosis with chemosis since 3 months [Image X (A)]. Patient is also operated outside for endoscopic sinus surgery 20 days ago which HPR came out to be esthesioneuroblastoma . MRI br ain with orbit andparanasal sinuses done which s uggestive of lesion involving right rhino orbital, erosions and rarefaction of bones along olfactory fossa medial orbital wall and ethmoid with areas of necrosis [Image XI(B, C)].

16. Hence, patient underwent right endoscopic sinus surgery with decompression of right orbit and debulking of tumour.HPR came small round cell tumour . Patient taken 33 radiotherapy and 5 chemotherapy, patient's proptosis completely relived in post op Post op Pet saen done which was also normal.

Image X(D) showing specimen of olfactory neuroblastoma and Image X(E) showing completely relived proptosis of patient after post operative ten cycle of radiotherapy.

17. Image D Image E

18. Case 5 A 44 year old female patient presented to ENT OPD with non-healing ulcer over tip of nose x 2 months. On examination: A solitary ulcer approx. 3 cmx 1.5 cm in size on Tip of nose, with ill defined margin and everted edges and slough covered floor with discharge. overlying skin tense, reddish in color extending toward right side of nose. Biopsy: Moderately differentiated squamous cell carcinoma of tip of nose

19. CT SCAN Nose : exophytic soft tissue density lesion at tip of nose Image 1. Pre op photo Image 2. CT neck

20. Image 3 and 4 intra op photos Image 5 post op photo

21. Histopathology examination: cutaneous squamous cell carcinoma of tip of nose p(T2)

Surgical management: Wide excision of growth over tip of nose + forehead flap reconstruction right thigh split thickness skin graft under general anesthesia

22. Discussion : The similarities of non-neoplastic and neoplastic lesion at initial presentation may lead to a significant delay in the diagnosis. Correlation of clinical, radiologic, and pathologic modalities is of utmost importance for accurate diagnosis. All these modalities are complementary to each other. The clinician must be aware of the varied presentations with different aetiologies and accordingly maintain a high index of suspicion to rule out a neoplastic etiology in all cases .

23. Conclusion : In our study, histopathology was the gold standard in deciding the accurate management. Early stage was a notable predictor of higher survival probability . Due to its rarity, heterogeneity of clinical behaviors, and variable outcomes makes it even more challenging.

24. References : Stell and Maran’s Textbook of Head and Neck Surgery and Oncology Otolaryngology– Head and Neck Surgery 1–9 American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016- DOI: 10.1177/0194599815627667

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