[Subcutaneous and intramuscular heterotopic calcification of the neck 42 years after radiotherapy]. / Subcutan és intramuscularis heterotop kalcifikáció a nyakon 42 évvel a sugárkezelést követoen.

Radiotherapy-induced heterotopic tissue calcification is an exceedingly rare complication in the head and neck region. We report a patient with extensive, radiotherapy-induced, combined subcutaneous and intramuscular, heterotopic calcification of the neck. An 80-year-old male presented with a 2-month history of severe dysphagia and a painful ulcer on the neck 42 years after salvage total laryngectomy following radiotherapy (total dose: 80 Gy) for a T3N0M0 glottic squamous cell carcinoma. We excluded recurrence or secondary malignancy by biopsy and performed computed tomography, which revealed subcutaneous and intramuscular calcification in the area of the skin ulcer and close to the hypopharyngeal wall, moreover, total occlusion of the common carotid and vertebral arteries bilaterally. Surgical correction involved removing the calcified lesions and closure using fasciocutaneous flap transposition. The patient has been asymptomatic for the past 48 months. Radiotherapy plays an essential role in the treatment of patients with head and neck squamous cell carcinoma. Distorted postoperative anatomy, excessive scar formation, radiotherapy-induced fibrosis as well as skin and subcutaneous tissue calcification can present as atypical findings. Orv Hetil. 2023; 164(10): 383-387.

Diagnostic difficulties and therapeutic options of a giant chest paraganglioma / Óriás mellkasi paraganglioma diagnosztikai nehézségei és terápiás lehetoségei

Paragangliomas are mostly benign tumors originating from the sympathetic or parasympathetic ganglions, but malignant forms are also known. They are in the region of the head and neck, in the glomus caroticum, intra-abdominally as well as in the thorax. The investigation of the 39-year-old male patient began due to extremely high blood pressure, night sweats and a 10 kg weight loss. Chest CT scan described a huge mass in the right hilum, bronchoscopic sampling was inconclusive. Tumor biopsy was performed through right thoracotomy, but complete resection was not possible due to tissue adhesions and cardiac involvement. Histological examination verified paraganglioma, which was also confirmed by laboratory tests. Accordingly, somatostatin analog therapy was initiated, followed by I-131-MIBG treatment with good clinical effect. Coronary angiography confirmed that the right coronary artery contributed with two marginal branches to the blood supply of the thoracic mass. The tumor was successfully removed and after the cardio-thoracic surgery, the patient's antihypertensive therapy was stopped. There was no sign of relapse during follow-ups. During the medical investigation of severe blood pressure elevations, the possibility of paraganglioma should be considered. In these cases, invasive procedures, if not preceded by proper medication, can be fatal. By taking advantage of the ever-expanding therapeutic options and the cooperation between institutions, even patients with a giant paraganglioma can become tumor-free.

Bilateral Parsonage-Turner syndrome after COVID-19 vaccination. A case report and review of the literature / Kétoldali Parsonage-Turner-szindróma COVID-19-vakcinációt követoen. Esetismertetés és az irodalom áttekintése

Parsonage---Turner syndrome (PTS; neuralgic amyotrophy) is a generally unilateral neuritis with sudden onset, severe shoulder or upper arm pain. Although the intense pain is usually self-limiting, two-thirds of patients experience pro-gressive motor weakness, narrowed range of motion, reflex changes, dysesthesias and chronic neuropathic pain in the shoulder girdle musculature and proximal upper limb muscles. The aetiology is unclear, in addition to some idiopath-ic cases the most common triggers of PTS are surgery, trauma, infection or vaccination. It is reported after SARS-CoV-2 infection, and unilateral PTS has been described in some cases following different types of COVID-19 vaccines. We are currently presenting the case of a middle-aged woman who developed partial neuralgic amyotrophy on the right shoulder one month after receiving the second dose of the BNT162b2 COVID-19 mRNA vaccine (Pfizer-BioNTech), and seven months later the symptoms appeared in the contralateral upper limb. The diagnosis of PTS was also confirmed by magnetic resonance and electrodiagnostic examination. The PTS is not an uncommon condi-tion, but in the absence of knowledge it is rarely thought of. The purpose of this report is to draw attention to the possibility of PTS in shoulder or upper arm pain following both SARS-CoV-2 infection and COVID-19 vaccination, as early diagnosis and adequate therapy may help to shorten the course of the disease.

Clinical importance of retropharyngeal lymph node metastases / A retropharyngealis nyirokcsomóáttétek klinikai jelentosége.

Összefoglaló. A retropharyngealis nyirokcsomóáttétek incidenciája a primer fej-nyaki daganat lokalizációjától függ. Leggyakrabban az elorehaladott vagy recidív nasopharynx-carcinomák esetén fordul elo, de III-IV. stádiumú oro- és hypopharynxtumorok esetén is megjelenhetnek. Non-nasopharyngealis primer tumoroknál a manifesztációjuk kedvezotlen prognosztikai faktornak tekintheto, melynek hátterében a diagnosztikus nehézség miatti késoi detektálás, a kifejezetten nehéz sebészi eltávolíthatóság, valamint az agresszív biológiai viselkedés állhat. Az esetismertetésünkben bemutatásra kerülo, 58 éves betegünknél bal oldali elülso szájfenéki primer tumort diagnosztizáltunk azonos oldali nyaki és retropharyngealis nyirokcsomó-metastasissal, mely a nemzetközi irodalom alapján extrém raritás, incidenciája kevesebb mint 1%. A retropharyngealis nyirokcsomók diagnosztikájában a lokalizáció miatt a képalkotóknak jut hangsúlyosabb szerep. Elhelyezkedésük nemcsak diagnosztikus, hanem sebésztechnikai kihívást is jelentenek az életfontosságú anatómiai képletek közelsége, illetve a szuk feltárási viszonyok miatt. Ilyenformán ezek a mutétek csak intenzív osztályos háttérrel és kello jártassággal rendelkezo centrumokban végezhetok. Az alapvetoen rossz prognózist a korai diagnózis és a multimodális terápia kedvezoen befolyásolja. Esetünkben a komplex kezeléssel (sebészi terápia és posztoperatív radiokemoterápia) sikerült lokoregionális tumormentességet elérni, és ezzel a teljes és a betegségmentes túlélési idot növelni. Orv Hetil. 2021; 162(25): 997-1003. Summary. The incidence of retropharyngeal lymph node metastasis depends on the localization of the primary head and neck cancer. Involved nodes are seen most commonly in cases of advanced or recurrent nasopharyngeal carcinoma, however, they might occur with stage III-IV oro- and hypopharyngeal tumours. The involvement of retropharyngeal lymph nodes has been associated with poor outcome of non-nasopharyngeal primary tumours, which might be explained by the delayed diagnosis, the difficult surgical procedure in the retropharyngeal space, and the aggressive nature of the disease. Here we present the case of a 58-year-old patient with an anterior oral cavity tumour on the left side with ipsilateral cervical lymph node and retropharyngeal lymph node metastases, which has been noted an extreme rarity in the literature with less than 1% incidence. Due to the localization of the retropharyngeal lymph nodes, the detection is based on imaging modalities. It represents a challenge for diagnosis and surgical treatment due to the close proximity of vital anatomical structures. Accordingly, these operations should only be performed in specialist surgical centres with intensive care units. The early diagnosis and the multimodality treatment might have a positive effect on the poor prognosis. In our case, we managed to achieve locoregional disease-free status with the complex treatment (surgical therapy and postoperative radiochemotherapy) and increase the overall and the disease-free survival. Orv Hetil. 2021; 162(25): 997-1003.

Colon cancer during the coronavirus pandemic ­ recovery from COVID-19 pneumonia of an elderly woman with multiple co-morbidities / Vastagbéldaganat a koronavírusjárvány idején - idos, multimorbid nobeteg COVID-19-tüdogyulladásának gyógyulása: (A COVID­19-pandémia orvosszakmai kérdései)

COVID-19, caused by the new coronavirus, can lead to acute respiratory failure or even sepsis. Patients with multiple co-morbidities are more likely to develop these severe forms of the disease. The aim of this report is to highlight cases the analysis of which might help discover factors that influence the course and mortality of COVID-19 pneumonia. The past medical history of our elderly patient (75-year-old female) includes rectum resection with intraoperative cardiac arrest and successful resuscitation. In January 2020, the patient was diagnosed with adenocarcinoma of the ascending colon and concomittant pulmonary embolism. Following 6 weeks of therapeutic dose low-molecular-weight heparin (LMWH) treatment, the cancerous colonic section was resected. The patient arrested intraoperatively but was successfully resuscitated. On post-operative day 15, the patient developed arterial anastomosis bleed, which necessitated acute right-sided hemicolectomy. Post-operatively she became pyrexial and COVID-19 was confirmed, but later became apyrexial with symptomatic treatment. Subsequently, the patient developed partial anastomosis insufficiency, which resolved with conservative management. Following three negative SARS-CoV-2 tests, she was successfully discharged from hospital. It is worthy of note that due to the active anastomosis bleed the angiotensin-converting enzyme (ACE)-inhibitor treatment was stopped, and later the patient got infected with SARS-CoV-2. A long-lasting LMWH therapy was performed. The timely management of colorectal carcinoms remains important even during an epidemic. The appropriate treatment of these patients during the pandemic presents a great challenge for all doctors, but, as shown in our case report, surgical treatment of even those with multiple co-morbidities can be successful. Orv Hetil. 2020; 161(25): 1059-1062.

[Surgical excision of a giant schwannoma located in the posterior mediastinum and partially in the retroperitoneum]. / Óriási, a hátsó mediastinumot és a retroperitoneumot részben kitölto schwannoma mutéti kezelése.

A characteristics of mediastinal disorders is that the high anatomical density of vital structures in this region represents a challenge for diagnosis and surgical treatment. Space-occupying lesions can grow without causing overt manifestations - or can progress symptom-free - hence they can reach an extreme size by the time of surgery. A 58-year-old male patient was hospitalized for pleural effusion and an extensive, space-occupying mediastinal lesion, which had been causing respiratory symptoms for 15 years. Cytology of the pleural effusion did not confirm malignancy. The CT scan depicted progression manifested as an increase in the size of the lesion with a likely site of origin in the left adrenal gland. According to the MRI, by contrast, the lesion might have originated in the region of vertebrae Th9-10, as suggested by the lack of dural continuity. However, its adrenal origin could not be excluded either; endocrine activity was not detected. An operation was performed with a neurosurgeon included in the surgical team. A spinal tumor of the size of 20.2 by 11.1 by 10.8 cm was removed through thoraco-laparotomy, and reconstruction of the diaphragm was performed. Histology confirmed a schwannoma. Postoperatively, the expansion of the lung was only partial, because the patient discontinued respiratory rehabilitation. The follow-up CT scan depicted local recurrence. In the lack of alternative therapeutic modalities, surgical resection is usually the sole option for the management of large, mediastinal space-occupying lesions diagnosed at an advanced stage. Such operations should only be performed in specialist surgical centers and with multidisciplinary collaboration. Orv Hetil. 2019; 160(37): 1476-1479.