RESUMO
We present a 56-year-old woman with metastatic follicular thyroid cancer at the nose tip with I uptake that is clinically rare, mimicking physiological uptake in the nose, a common finding seen after routine I therapeutic imaging. The lesion revealed a metastatic follicular thyroid cancer with I uptake and response to I therapy. Surgical removal, however, was not performed due to cosmetic and functional considerations. Active surveillance is warranted owing to its relative aggressiveness in nature.
Assuntos
Adenocarcinoma Folicular/patologia , Radioisótopos do Iodo/metabolismo , Neoplasias Nasais/metabolismo , Neoplasias Nasais/secundário , Transporte Biológico , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Nasais/diagnóstico por imagemRESUMO
A 56-year-old man presented with intermittent epistaxis. Nasopharyngoscope revealed a hemorrhagic mass occupying the left nasal cavity. The patient had a history of renal clear cell carcinoma. F-FDG PET/CT was performed to evaluate the potential lesions systematically. PET/CT images showed low to moderate activity in the region of nasal cavity and paranasal sinuses. No abnormal uptake of F-FDG was observed in the rest of the body. Eventually, the mass was pathologically proved to be metastatic renal clear cell carcinoma.
Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Neoplasias Nasais/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Carcinoma de Células Renais/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/secundário , Compostos RadiofarmacêuticosRESUMO
WHO first recognised extranodal NK/T-cell lymphoma (ENKTCL) in 2001, thanks to technical advances in anatomopathology and immunohistochemistry. It is divided into nasal and extranasal subgroups depending on the primary site. Primary isolated NK/T-cell lymphoma of the testis is rare. Typical recurrence sites of primary testicular NK/T-cell lymphoma are the gastrointestinal tract, lymph nodes, skin, spleen and central nervous system. Nasal relapses of a primary NK/T-cell lymphoma of the testis are very rare and according to our knowledge, no other case has been reported yet in the literature. The authors report the case of a 35-year-old Caucasian man relapsing twice in the nasal cavity 1 year after initial diagnosis and treatment of a primary isolated, stage IE, ENKTCL of the testis. We report the clinical and radiological presentation of the nasal relapses and the different modalities of treatment that were applied. Sinonasal relapses of an isolated primary NK/T-cell lymphoma of the testis are very rare. ENKTCL is a very aggressive entity, even at an early stage, therefore, requiring a multimodal treatment approach including chemotherapy and radiotherapy. New strategies to treat this disease are needed.
Assuntos
Linfoma Extranodal de Células T-NK/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Nasais/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto , Terapia Combinada , Diagnóstico Diferencial , Humanos , Linfoma Extranodal de Células T-NK/patologia , Linfoma Extranodal de Células T-NK/terapia , Masculino , Metástase Neoplásica , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/secundário , Neoplasias Nasais/terapia , Tomografia por Emissão de Pósitrons , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Ear involvement by non-Hodgkin lymphoma is quite rare and can be mistaken for other common lesions encountered in otolaryngology. The literature on this subject is also limited. CASE SUMMARY: A 45-year-old man with bilateral ear nodules that progressed over two years. Biopsy of the right ear revealed a B-cell small lymphocytic lymphoma (SLL). The patient responded to radiotherapy well. He received an additional dose two months after the initial treatment because of a remaining nodularity on the right earlobe. After several months, he presented a new lesion on his nasal tip, for which a biopsy confirmed a lymphoma relapse. The patient was managed with oral prednisone and low-dose radiation with a favourable response. DISCUSSION: This case highlights the importance of including lymphoma in the differential diagnosis of ear lesions from an otolaryngology perspective. A biopsy of any lesion or nodule with an atypical course should be considered for appropriate diagnosis and management.
Assuntos
Pavilhão Auricular , Neoplasias da Orelha , Leucemia Linfocítica Crônica de Células B , Neoplasias Primárias Múltiplas , Neoplasias da Orelha/tratamento farmacológico , Neoplasias da Orelha/patologia , Neoplasias da Orelha/radioterapia , Humanos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucemia Linfocítica Crônica de Células B/patologia , Leucemia Linfocítica Crônica de Células B/radioterapia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/radioterapia , Neoplasias Nasais/secundário , Doses de RadiaçãoRESUMO
PURPOSE OF THE REVIEW: We clarify clinical characteristics of patients with immune checkpoint inhibitor (ICI)-induced myositis. RECENT FINDINGS: In 13 of 15 cases with ICI-induced myositis, the type of malignancy was melanoma. Eight, 4, and 3 patients received anti-PD-1 alone, anti-CTLA4 alone, and a combination of those, respectively. The mean period to the onset of ICI-induced myositis from the initiation of ICI was 4 weeks. Myocarditis was a complication in five patients. Seven of the patients died. The causes of death were myocarditis in three patients, respiratory muscle paralysis in two patients, and cancer progression in two patients. In patients without myocarditis or respiratory muscle paralysis, the prognosis for myositis was favorable with normalization of the CK levels occurring upon the cessation of ICI and the administration of immunosuppressive agents. Myocarditis and respiratory muscle paralysis are the major causes of death as immune-related adverse events in patients with ICI-induced myositis.
Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Dermatomiosite/induzido quimicamente , Melanoma/tratamento farmacológico , Nivolumabe/efeitos adversos , Neoplasias Nasais/tratamento farmacológico , Neoplasias Cutâneas/patologia , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/efeitos adversos , Feminino , Humanos , Pneumonias Intersticiais Idiopáticas/complicações , Ipilimumab/efeitos adversos , Linfonodos/patologia , Melanoma/secundário , Miocardite/induzido quimicamente , Miosite/induzido quimicamente , Neoplasias Nasais/secundário , Paralisia Respiratória/induzido quimicamenteRESUMO
RATIONALE: Patients with nasal metastases are seldom seen among clear cell renal cell carcinoma (CCRCC). We report a rare case presenting as a solitary nasal cutaneous nodule, and summarize the therapeutic experience of tyrosine kinase inhibitors (TKIs). PATIENT CONCERNS: A 86-year-old man with a chief complaint of continuous back pain for 3 months and discovery of a cutaneous nodule on the nose for a month visited the oncology department of our hospital. Maxillofacial computed tomography (CT) scans demonstrated a 1.5â×â0.9âcm and ovoid soft tissue density shade at dorsum of the nose. CT of abdomen revealed a 3.5â×â2.7âcm mass in right kidney and presenting an obvious heterogeneous enhancement. DIAGNOSES: The pathological examination of nasal excision biopsy confirmed the diagnosis of nasal clear cell carcinoma. Immunohistochemical analysis indicated that the nasal metastatic tumor had a renal origin. INTERVENTIONS: Sunitinib at a dose of 50âmg/day was administered initially, while the serious cutaneous toxicities, especially hand-foot syndrome, occurred to the patient. Subsequently, axitinib at a dose of 5âmg twice daily was accepted as second-line treatment. OUTCOMES: The nasal mass shrinked significantly after 8-week treatment of axitinib, and the primary tumor has been stable till now. LESSONS: Axitinib successfully controlled the nasal cutaneous metastasis with mild adverse reactions, and did not aggravate the cutaneous toxicities resulting from sunitinib. The incidence of cutaneous adverse events were low which had been reported by previous studies; however, it is difficult to say that axitinib is a more effective treatment modality for RCC with nasal metastases, which requires further studies.
Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Neoplasias Nasais/tratamento farmacológico , Neoplasias Nasais/secundário , Inibidores de Proteínas Quinases/uso terapêutico , Idoso de 80 Anos ou mais , Axitinibe/uso terapêutico , Humanos , Masculino , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos , Sunitinibe/efeitos adversosRESUMO
BACKGROUND: Esthesioneuroblastoma (ENB) is a rare neuroendocrine tumor. The purpose of this study was to compare the Kadish, tumor-node-metastasis (TNM), and Dulguerov's modified TNM staging in order to determine the impact of the stage on primary surgical treatment selection, margin status, and survival. METHODS: The National Cancer Database (NCDB) was used to identify patients diagnosed with ENB between 2004 to 2015. Patients were excluded based on the ability to properly stage their disease as well as the availability of treatment data. RESULTS: Eight-hundred eighty-three patients had sufficient data for analysis. On multivariate analysis, age and government insurance were associated with primary surgical treatment, whereas tumor stage, gender, race, hospital type and volume, and comorbidity score were not. Age, charlson-deyo comorbidity (CDCC) score, hospital volume, and nodal status were found to be predictors of survival. Multivariate-analysis controlling for stage failed to demonstrate clear survival differences between staging in both TNM and Kadish systems. T-stage and the presence of regional nodal metastasis were associated with an increased risk of positive margins on multivariate analysis. CONCLUSION: Although primary surgical management and positive margins can be predicted by certain patient and tumor factors, clinical staging systems for ENB poorly predict prognosis over a 10-year horizon.
Assuntos
Estesioneuroblastoma Olfatório/patologia , Cavidade Nasal/patologia , Neoplasias Nasais/secundário , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estesioneuroblastoma Olfatório/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Estadiamento de Neoplasias , Neoplasias Nasais/cirurgia , Prognóstico , Taxa de SobrevidaRESUMO
RATIONALE: Distant metastasis of clear-cell renal cell carcinoma (ccRCC) to the nasal cavity and paranasal sinus is rare. Endoscopic biopsy used to be performed for diagnosis when it is difficult for complete resection due to intense bleeding during surgery. According to previous literature, the outcomes of metastasis after endoscopic surgery remain unclear. PATIENT CONCERNS: A 62-year-old man with a history of epistaxis was referred to our institution. The clinical, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate metastasis to sinonasal sinuses.Diagnoses: He was histopathologically diagnosed with different anatomical structures of nasal cavity and paranasal sinus metastases 6, 14, and 15 years after the initial nephrectomy for ccRCC. INTERVENTIONS: He underwent endoscopic surgery 3 times, once at the time of each metastasis. OUTCOMES: He survived for 20 years despite of multitransfers and died due to multiple organ failure. LESSONS: Metastasis of ccRCC to the nasal cavity and paranasal sinus is characterized by varied growth rates, metastatic times and spreading patterns; ccRCC metastasis should be considered with the presence of hemorrhagic lesions in the nasal cavity and paranasal sinus. Endoscopic surgery is the first-line treatment.
Assuntos
Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Neoplasias Nasais/secundário , Neoplasias dos Seios Paranasais/secundário , Carcinoma de Células Renais/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagemRESUMO
The metastatic spread of infraclavicular malignancies to the nasal cavity is rare. We describe the case of a 58-year-old man who presented with a 4-month history of right-sided rhinorrhoea, maxillary hypoesthesia, hyposmia and hypogeusia. Clinical examination revealed an irregular mass within the right nasal cavity. Immunohistochemical analyses of biopsies were consistent with small cell carcinoma of indeterminate origin. A positron emission tomography scan demonstrated extensive mediastinal lymphadenopathy with collapse-consolidation of the right lung's middle lobe and no other sites of metastasis. Following discussion at the lung multidisciplinary team meeting, a diagnosis of metastatic small cell lung cancer (SCLC) was made; the patient was staged with N3, M1b disease and palliative chemo-radiotherapy was started. To the best of our knowledge, this report represents the first documented case of a solitary nasal cavity metastasis arising from a SCLC.
Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Nasais/secundário , Carcinoma de Pequenas Células do Pulmão/secundário , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Neoplasias Nasais/diagnóstico , Rinite/diagnóstico , Carcinoma de Pequenas Células do Pulmão/diagnósticoRESUMO
A 64-year-old man found a painless soft tissue mass on his nasal tip 3 months ago. The biopsy pathology indicated a metastatic squamous carcinoma. An F-FDG PET/CT scan was performed to detect the primary malignancy, and it demonstrated multiple F-FDG-avid lesions involving the nasal tip, bilateral lungs, right hilum and mediastinum, and rectum. The nasal-tip mass with high radioactivity was diagnosed as the metastasis from squamous lung carcinoma, which was confirmed by the biopsy of a lung lesion.
Assuntos
Carcinoma de Células Escamosas/patologia , Fluordesoxiglucose F18 , Neoplasias Pulmonares/patologia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/secundário , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Biópsia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Neoplasias Nasais/diagnóstico , Seios Paranasais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Quimiorradioterapia , Procedimentos Cirúrgicos de Citorredução , Endoscopia , Epistaxe , Feminino , Cefaleia , Humanos , Indazóis , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Obstrução Nasal , Neoplasias Nasais/secundário , Neoplasias Nasais/terapia , Seios Paranasais/patologia , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Renal cell carcinoma is one of the most common tumours to spread by extranodal metastases to the head and neck. Metastatic renal cell carcinoma to the head and neck area has been demonstrated mostly in the paranasal sinuses, parotid gland, the mandible, larynx and hypopharinx. Renal cell carcinoma should be excluded whenever a metastatic lesion is encountered in the head and neck area, even if the metastatic lesion is the first clinical presentation. The diagnosis of metastatic RCC should be suspected in any patient with even a remote history of renal cell carcinoma. We report a case of 79 year old woman with recurrent episodes of rhinorrhea, headache, hyposmia and monolateral right epistaxis, with a history of RCC. We describe RCC nasal metastases in a metachronous bilateral neoplasm, in which a second occult lesion debuted with a homolateral nasal metastases, ten years after left nephrectomy.
Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Neoplasias Nasais/diagnóstico por imagem , Idoso , Carcinoma de Células Renais/patologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Renais/patologia , Imageamento por Ressonância Magnética , Nasofaringe/diagnóstico por imagem , Nasofaringe/patologia , Metástase Neoplásica , Neoplasias Nasais/secundário , Tomografia Computadorizada por Raios XRESUMO
A 73-year-old male patient underwent a right nephrectomy for renal cell carcinoma in 2008, and interferon-alpha was initiated as adjuvant treatment. Computed tomography (CT) scans showed lymphadenopathy above the left diaphragm, and treatment with interferon-2 was subsequently initiated in 2009. Nasal bleeding manifested in February 2010, and CT scans showed a soft-tissue density mass mainly located in the ethmoid sinus. A biopsy of the lesion was performed, and metastatic renal cell carcinoma was diagnosed. Treatment with sorafenib was consequently initiated and the paranasal metastasis showed a temporary partial response (PR). However, the metastatic lesion increased in size and caused repeated nasal bleeding that required blood transfusion. Although treatment with everolims was initiated, adverse events, such as rush, hypertensionnemia, and anemia due to nasal bleeding, developed. Treatment with axitinib was subsequently initiated. However, because adverse events, such as severe diarrhea, renal dysfunction and proteinuria manifested, the dose of axitinib was gradually decreased, and a periodic drug withdrawal schedule (11 days on, 3 days off) was finally initiated, which controlled these adverse events. The metastatic lesions showed a PR for 31months following axitinib administration.
Assuntos
Carcinoma de Células Renais/tratamento farmacológico , Imidazóis/uso terapêutico , Indazóis/uso terapêutico , Neoplasias Renais/tratamento farmacológico , Neoplasias Nasais/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Axitinibe , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/secundário , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Abstract Metastatic ovarian cancer uncommonly presents with skin metastasis. When present, skin metastases of ovarian cancer are usually localized in the vicinity of the primary tumor. We report a case of a 58-year-old woman with a rapid growing erythematous, well-defined nodule localized on the left nasal ala. A skin biopsy was performed and histopathological and immunohistochemical findings were compatible with a cutaneous metastasis of adenocarcinoma. A systematic investigation revealed a bilateral ovarian cystadenocarcinoma associated with visceral dissemination, likely associated with nose cutaneous metastasis. We report a very uncommon case because of the presentation of ovarian carcinoma as cutaneous metastasis. To our knowledge, this atypical localization on the nose has not been described yet in the literature.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Cutâneas/secundário , Carcinoma/secundário , Neoplasias Nasais/secundário , Neoplasias Ovarianas/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/patologia , Biópsia , Carcinoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias Nasais/patologiaAssuntos
Adenocarcinoma/patologia , Neoplasias da Mama Masculina/patologia , Neoplasias Nasofaríngeas/secundário , Neoplasias Nasais/secundário , Idoso , Biópsia por Agulha Fina , Neoplasias da Mama Masculina/mortalidade , Neoplasias da Mama Masculina/terapia , Humanos , Masculino , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasais/mortalidade , Neoplasias Nasais/patologia , Seios Paranasais/patologiaRESUMO
A 59-year-old man was admitted to the Department of Ear, Nose and Throat with a complaint of six-month history of left facial numbness and toothache. There was no special previous medical history in addition to smoking. No obvious abnormality in routine electrocardiogram, chest X-ray, abdominal B ultrasound were found. (1) CT scans showed heterogeneous shadows in maxillary sinus with the lesions on the left max- illary bone and evidently destruction of alveolar bone. The histopathological examination revealed bone tissue which was partly covered by an intact adenocarcinoma cell. (2) Immunohistochemical staining foe CK7, CD117, thyroid transcription factor-1, and novel aspartic proteinase A were positive and thus compatible with metastatic lung adenocarcinoma. (3) Chest CT scans showed a 1 cm x 2 cm mass on the superior lobe of the left lung, with destruction of sternum and rib, confirming that the lesions in the paranasal sinuses were lung cancer metastases. Therefore, this patient conclusively diagnosed as lung adenocarcinoma with multiple bone metastases.
Assuntos
Adenocarcinoma/patologia , Neoplasias Ósseas/secundário , Neoplasias Pulmonares/patologia , Seio Maxilar/patologia , Neoplasias Nasais/secundário , Adenocarcinoma/diagnóstico , Adenocarcinoma de Pulmão , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-IdadeRESUMO
Metastatic ovarian cancer uncommonly presents with skin metastasis. When present, skin metastases of ovarian cancer are usually localized in the vicinity of the primary tumor. We report a case of a 58-year-old woman with a rapid growing erythematous, well-defined nodule localized on the left nasal ala. A skin biopsy was performed and histopathological and immunohistochemical findings were compatible with a cutaneous metastasis of adenocarcinoma. A systematic investigation revealed a bilateral ovarian cystadenocarcinoma associated with visceral dissemination, likely associated with nose cutaneous metastasis. We report a very uncommon case because of the presentation of ovarian carcinoma as cutaneous metastasis. To our knowledge, this atypical localization on the nose has not been described yet in the literature.