Osteoradionecrosis of the subaxial cervical spine following treatment for head and neck carcinomas.

OBJECTIVE: To study MRI and positron emission tomography (PET)/CT imaging of osteoradionecrosis (ORN) of the subaxial cervical spine, a serious long-term complication of radiation therapy (RT) for head and neck cancers that can lead to pain, vertebral instability, myelopathy and cord compression. METHODS: This is a single-institution retrospective review of patients diagnosed and treated for ORN of the subaxial cervical spine following surgery and radiation for head and neck cancer. RESULTS: We report PET/CT imaging and MRI for four patients, each with extensive treatment for recurrent head and neck cancer. Osteomyelitis (OM) and discitis are the end-stage manifestations of ORN of the subaxial spine. CONCLUSION: ORN of the subaxial spine has variable imaging appearance and needs to be differentiated from recurrent or metastatic disease. Surgical violation of the posterior pharyngeal wall on top of the compromised vasculature in patients treated heavily with RT may pre-dispose the subaxial cervical vertebrae to ORN, with possible resultant OM and discitis. MRI and PET/CT imaging are complimentary in this setting. PET/CT images may be misinterpreted in view of the history of head and neck cancer. MRI should be utilized for definitive diagnosis of OM and discitis in view of its imaging specificity. ADVANCES IN KNOWLEDGE: We identify the end-stage manifestation of ORN in the sub-axial spine on PET/CT and MRI to facilitate its correct diagnosis.

Management of sarcomatoid salivary duct carcinoma of the submandibular gland duct with coexisting seropositive human immunodeficiency virus.

BACKGROUND: Sarcomatoid salivary duct carcinoma of the submandibular gland is extremely rare. This paper highlights the impact of surgery and adjuvant radiation therapy on the outcome of this disease. METHODS: A 59-year-old man with human immunodeficiency virus presented with a painless, rapidly growing left neck mass. Biopsy followed by surgical excision of the left submandibular gland revealed sarcomatoid salivary duct carcinoma of the submandibular gland duct with perineural invasion and close margins, for which he underwent adjuvant radiotherapy. Post-operative positron emission tomography and computed tomography revealed no residual or metastatic disease. Pathological analysis of tumour-node-metastasis staging revealed a T2 N0 M0 (stage II) tumour. RESULTS: The patient tolerated his treatment without serious acute or long-term side effects. There was no evidence of disease on comprehensive examination or on positron emission tomography or computed tomography scans at the 4.6-year follow up. CONCLUSION: Surgery followed by adjuvant radiotherapy provided practical locoregional control with acceptable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.

Trimodality approach for ceruminous mucoepidermoid carcinoma of the external auditory canal.

BACKGROUND: Ceruminous mucoepidermoid carcinoma of the external auditory canal is extremely rare. This paper highlights the impact of concurrent chemoradiotherapy on the outcomes of this disease. CASE REPORT: A 47-year-old female presented with a 2-month history of otalgia and a mass in her right ear. Biopsy revealed high grade ceruminous mucoepidermoid carcinoma. She underwent surgical excision of the right external auditory canal and right upper neck dissection. Pathological analysis of tumour-node-metastasis staging revealed a T2 N0 (stage II) tumour. One year later, computed tomography scanning of the temporal bone showed tumour recurrence. Biopsy revealed recurrent ceruminous mucoepidermoid carcinoma. The patient underwent salvage resection. Pathology revealed that the tumour was diffusely invading nearby structures, with perineural invasion, lymphatic spread and extracapsular extension. Pathological analysis of tumour-node-metastasis staging revealed a T3 N1 M0 (recurrent stage IV) tumour. RESULTS: The patient subsequently received concurrent chemoradiotherapy. There was no evidence of disease at 37 months' follow up. CONCLUSION: The trimodality approach, using surgery plus concurrent chemoradiotherapy, provided reasonable loco-regional control with tolerable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.