MyMedR

Fulltext Nodular fasciitis: a diagnostic dilemma

Mallina S, Rosalind S, Philip R, Harvinder S, Gurdeep S, Sabaria MN

Med J Malaysia, 2007 Dec;62(5):420-1.

A 65 year old man presented with a right upper cervical mass. A diagnosis of pleomorphic adenoma was reported on fine needle aspiration cytology (FNAC). CT scan however reported an intramuscular sternocleidomastoid swelling. The tumor was excised and a diagnosis of nodular fasciitis was made. It is important to be aware of this diagnosis and that FNAC reports may mimic that of a pleomorphic adenoma.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis

Fulltext Ni endoscopic classification for Storz Professional Image Enhancement System (SPIES) endoscopy in the detection of upper aerodigestive tract (UADT) tumours

Abdullah B, Rasid NSA, Lazim NM, Volgger V, Betz CS, Mohammad ZW, et al.

Sci Rep, 2020 04 24;10(1):6941.

PMID: 32332848 DOI: 10.1038/s41598-020-64011-6

The diagnostic procedure for upper aerodigestive tract (UADT) tumours is by white light endoscopy (WLE) combined with biopsy. However, WLE has difficulty identifying minute epithelial changes which hinders early diagnosis. Storz Professional Image Enhancement System (SPIES) is designed to enhance the visualization of microvasculature on the mucosal surface and detect any epithelial changes. In this study, we aimed to evaluate the use of Ni endoscopic classification with SPIES endoscopy in the detection of UADT tumours. Fifty-nine patients with suspected UADT tumours underwent WLE followed by SPIES endoscopy. All the tumours were biopsied and sent for histopathological examination (HPE). The kappa index (κ) was used to evaluate the agreement between the methods. The level of agreement between SPIES using Ni classification and HPE showed almost perfect agreement as compared to moderate agreement between WLE and HPE. The sensitivity and specificity for WLE and HPE were 77.5% and 84.2% respectively with positive predictive value (PPV) of 91.2% and negative predictive value (NPV) of 64%. The sensitivity and specificity for SPIES endoscopy using Ni classification and HPE were 97.5% and 94.7% respectively with PPV of 97.5% and NPV of 94.7%. SPIES endoscopy using Ni classification is a valid tool for earlier tumour detection.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Fulltext Congenital mature cystic teratoma of the lateral neck presenting as cystic hygroma: a rare case report with literature review

Win TT, Razy N, Hamid S, Ubramanian AB, Ramalinggam G

Turk Patoloji Derg, 2014;30(3):220-4.

PMID: 24715558 DOI: 10.5146/tjpath.2013.01220

Teratoma of the neck is a rare extra-gonadal teratoma. Although it can be seen in adult, most of the cases present in fetal life or early childhood. Grading and classification of teratoma is important for management and prognosis. Decision making between mature and immature teratoma is sometime challenging if it is not composed of extensive unusual neuroectodermal tissue component. We reported a rare case of huge congenital mature cystic teratoma composted of various neuroectodermal tissues in an 8-month-old boy; it was located at the lateral neck and mimicked congenital cystic hygroma. A literature review was done to grade and classify the tumour.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Fulltext Cervical schwannoma: report of four cases

Rohaizam J, Tang IP, Jong DE, Tan TY, Narihan MZ

Med J Malaysia, 2012 Jun;67(3):345-8.

PMID: 23082435 MyJurnal

Extracranial schwannomas in the head and neck region are rare neoplasms. The tumours often present as asymptomatic, slowly enlarging lateral neck masses and determination of the nerve origin is not often made until the time of surgery. Preoperative diagnosis maybe aided by imaging studies such as magnetic resonance imaging or computed tomography, while open biopsy is no longer recommended. The accepted treatment for these tumors is surgical resection with preservation of the neural pathway. We report four cases of cervical schwannomas that we encountered at our center during four years of period. The clinical features, diagnosis and origin, management and pathological findings of these benign tumors are discussed.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Fulltext An extensive cervical vagal nerve schwannoma: a case report

Chiun KC, Tang IP, Prepageran N, Jayalakshmi P

Med J Malaysia, 2012 Jun;67(3):342-4.

PMID: 23082434 MyJurnal

Vagal nerve schwannoma is extremely rare. The majority of cases present with a slow growing neck swelling without neurological deficit. Magnetic resonance imaging is the gold standard investigation to establish a pre-operative diagnosis. We report a case of a 32-year-old man with an extensive right vagal nerve schwannoma involving the right jugular foramen and parapharyngeal space. The tumour was resected via a transcervical approach. Complete excision of the tumour is the key to prevent recurrence.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Fulltext Head and neck cancer: possible causes for delay in diagnosis and treatment

Lee SC, Tang IP, Avatar SP, Ahmad N, Selva KS, Tay KK, et al.

Med J Malaysia, 2011 Jun;66(2):101-4.

PMID: 22106686 MyJurnal

To explore the possible causes for delay in diagnosis and treatment of head and neck cancer at Sarawak General Hospital (SGH).

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Lymphoma with superimposed tuberculosis and fungal infection mimicking parapharyngeal abscess complicated with recurrent neurocardiogenic syncope: a case report

Sharudin SN, Huda Al Firdas AN, Hitam S, Hamid Z, Nordin NJ, Othman N, et al.

Malays J Pathol, 2020 Aug;42(2):287-291.

PMID: 32860384

INTRODUCTION: Lymphoma of parapharyngeal space (PPS) is a rare condition. The clinical presentations may vary and often masquerades as infection or an inflammatory condition. A misdiagnosis will lead to a delay in treatment of the disease. Due to the complex anatomy of PPS, any attributed pressure from masses can lead to a life-threatening event such as cardiac syncope.

CASE REPORT: We report a rare case of PPS B-cell non-Hodgkin lymphoma with superimposed Tuberculosis (TB) and fungal infection that presents with several episodes of syncope and hemodynamic depression.

DISCUSSION: The clinical entities in PPS lesions syncope and its associated syndromes, pathophysiology, and differential diagnosis together with possible managements are further discussed.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis

Parotid gland oncocytic carcinoma: A rare entity in head and neck region

Wan Ahmad Kammal WS, Azman M, Salleh AA, Md Pauzi SH, Abd Shukor N

Malays J Pathol, 2020 Aug;42(2):283-286.

PMID: 32860383

Oncocytic carcinoma of the salivary gland is an uncommon tumour in the head and neck region. Owing to its rarity, identifying the histopathological features of a malignant tumour can be difficult and challenging. We report a case of a 70-year-old man who presented with a left facial weakness for six months in a background history of left parotid swelling over the past 10 years. Clinical examination revealed a 3x3cm left parotid mass and grade 4 facial nerve palsy. Fine needle aspiration of the mass showed scattered cohesive, monolayered sheets of uniform oncocytic cells. Subsequently, a left total parotidectomy and selective neck dissection were performed. Histological examination showed sheets of small oncocytes with minimal nuclear atypia. Evidence of nerve entrapment, capsular invasion and perivascular permeation were identified in focal areas. Thus, a final diagnosis of oncocytic carcinoma was rendered.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis

Monophasic synovial sarcoma of the pyriform fossa

Ng CT, Wong EHC, Prepageran N

BMJ Case Rep, 2020 Nov 30;13(11).

PMID: 33257363 DOI: 10.1136/bcr-2020-236204

Head and neck synovial sarcoma is rare. We report the case of a 71-year-old man who presented with progressive dysphagia, odynophagia, shortness of breath on exertion and hoarseness of voice. Nasendoscopy revealed a smooth, non-fungating, non-ulcerative mass arising from the left lateral pharyngeal wall. CT showed a well-defined, heterogenous enhancing lesion arising from the left pyriform fossa. Initial biopsy taken was inconclusive and patient underwent a transcervical complete excision of the tumour, where histopathological analysis confirmed the diagnosis of monophasic synovial sarcoma of the left pyriform fossa. This patient also received adjuvant radiotherapy postoperatively and remained disease free 1 year after completion of treatment.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis

Fulltext Branchial fistula--a review

Lee ST, Krishnan MM

Singapore Med J, 1991 Feb;32(1):50-2.

PMID: 2017707

Congenital branchial fistula and their embryology is well described in the literature. The accepted standard treatment method includes stepladder excision for extensive fistulas. This paper presents two cases (Case 1 and 2) which are embryologically typical of second and third arch origin respectively; and a third case (Case 3) which has not been previously described. Case 3 appears to be a hitherto unreported combination of first and second arch origin. Case 1 and 2 were treated via a standard stepladder excision approach. A different newer approach was utilised in Case 3, that is, stripping of the fistulous tract with Myer's vein stripper. Unlike the stepladder approach, this is simple and avoids extensive time consuming dissection. However, being a blind procedure, it is not generally advocated if vital structures exist in the proximity.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Comparison of Serum Fucose Levels in Leukoplakia and Oral Cancer Patients

Rai NP, Anekar J, Shivaraja Shankara YM, Divakar DD, Al Kheraif AA, Ramakrishnaiah R, et al.

Asian Pac J Cancer Prev, 2015;16(17):7497-500.

PMID: 26625751

BACKGROUND: Tumor markers, designated as a broad group of substances produced by malignancies, could be in the form of biochemical substances, immunological substances, cell surface changes and genetic alterations. Cancer, a disorder of cellular behavior is characterized by alteration of serum glycoproteins. L-fucose, a hexose, which is the terminal sugar in most of the plasma glycoproteins, may be useful as a tumor marker for the detection, monitoring and prognostic assessment of malignancies. The aim of the study was to ascertain the role of serum fucose as a biomarker for early detection of oral cancer and to compare serum fucose levels in healthy controls, leukoplakia and oral cancer patients.

MATERIALS AND METHODS: The study included 60 (100.0%) subjects, who were grouped as 20 (33.3%) control subjects, 20 (33.3%) squamous cell carcinoma patients and 20 (33.3%) leukoplakia patients. Fucose estimation was done using UV-visible spectrophotometry based on the method as adopted by Winzler using cysteine reagent. The results were analyzed statistically using ANOVA with Bonferroni post hoc tests.

RESULTS: Results showed a high significance in serum fucose in oral squamous cell carcinoma (OSCC) and leukoplakia subjects compared to normal controls. There was a gradual increase in the values noted from control to leukoplakia and to squamous cell carcinoma.

CONCLUSIONS: Estimation of serum fucose may be a reliable marker and can be used as an effective diagnostic biomarker in oral squamous cell carcinoma patients.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis

Recurrent occipital dermatofibrosarcoma protuberans tackled with wide local excision: A case report and current management

Kho JPY, Ng BHK, John R

Med J Malaysia, 2019 02;74(1):82-84.

PMID: 30846668

Dermatofibrosarcoma protuberans (DFSP) is a slowgrowing, locally invasive tumour of the dermis. It commonly presents in the trunks and proximal extremities but is seen to a lesser extent in the head and neck regions. We present a case report of a recurrent DFSP in a 48-year-old Iban woman at the occipital region. The patient underwent wide local excision and removal of outer table of cranium, dressing followed by split thickness skin graft. Histopathological examination confirmed dermatofibrosarcoma protuberans with clear lateral surgical margins and a deep margin of 0.5mm. She is currently undergoing radiotherapy and is planned for 50Grey 25cycles.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis

Fulltext Expression of Ki-67, Cornulin and ISG15 in non-involved mucosal surgical margins as predictive markers for relapse in oral squamous cell carcinoma (OSCC)

Govindaraj PK, Kallarakkal TG, Mohd Zain R, Tilakaratne WM, Lew HL

PLoS One, 2021;16(12):e0261575.

PMID: 34941961 DOI: 10.1371/journal.pone.0261575

BACKGROUND: Local relapse of oral squamous cell carcinoma in non-involved mucosal surgical margins indicated possibility of field alteration in the margins, which could be predicted with certain biomarkers. The objectives were to evaluate the expression of Ki-67, Cornulin and ISG15 in non-involved mucosal surgical margins and the association of clinicopathological prognosticators with local relapse in oral squamous cell carcinoma.

METHODS: Surgical margins from the study (relapse) group (n = 23), control (non-relapse) group (n = 32) and normal oral mucosa (n = 5) were immunohistochemically stained using Ki-67, Cornulin and ISG15 antibodies. Association between expression of markers and clinicopathological prognosticators with local relapse in oral squamous cell carcinoma was analyzed statistically.

RESULTS: The study group surgical margins demonstrated significantly decreased Cornulin expression (p = 0.032). Low Cornulin expression was significantly associated with local relapse (p = 0.004) and non-tongue primary tumor (p = 0.013). Although not significantly associated with local relapse, expression of Ki-67 was significantly reduced in female patients (p = 0.041). Age above 57.5 years, Chinese & Indian ethnicity, alcohol consumption, epithelial dysplasia in surgical margins, and type III and IV patterns of invasion of tumor were also significantly related to local relapse. Regression analysis showed low expression of Cornulin (p = 0.018), and increased patient's age (p = 0.008) were predictors of local relapse in oral squamous cell carcinoma, with 34-fold risk and 18-fold risk, respectively. Expression of Ki-67 and ISG15 did not show significant association with local relapse in oral squamous cell carcinoma.

CONCLUSION: Low expression of Cornulin is an independent predictor of relapse in oral squamous cell carcinoma.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Fulltext Surgical access to parapharyngeal space tumours--the Manipal experience

Hazarika P, Dipak RN, Parul P, Kailesh P

Med J Malaysia, 2004 Aug;59(3):323-9.

PMID: 15727377

A few series of parapharyngeal space tumours have been reported earlier but recently not many series have been published in English literature. It is rare for any medical center, let alone an individual surgeon, to develop sufficient experience in evaluating these tumours. We present our experience in the treatment of 41 cases of parapharyngeal tumours from January 1992 to December 2001. FNAC, ultrasound and CT scan of the presenting mass was done in most of the patients as the main pre-operative work-up. The strategic location and extension of the tumour may occasionally alter the surgical approach for tumour excision.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Metastatic Pleomorphic Adenoma in the infratemporal fossa and neck following total parotidectomy after 30 years

Wong DKC, Muhamad NS, Sobri SS, Amin WAM, Yusof Z

Med J Malaysia, 2019 04;74(2):85-86.

PMID: 31079134

Metastasising pleomorphic adenoma is rare and may occur years after surgical excision of a pleomorphic adenoma (PA). We present a 61-year-old woman with a right infratemporal PA with metastases to the cervical lymph nodes after 30 years following a total parotidectomy. She was treated successfully with a resection of the tumour with combined neck and mandibulotomy approach along with postoperative radiotherapy given subsequently.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis*

Fulltext Dopamine-secreting phaeochromocytomas and paragangliomas: clinical features and management

Foo SH, Chan SP, Ananda V, Rajasingam V

Singapore Med J, 2010 May;51(5):e89-93.

PMID: 20593136

Most functional phaeochromocytomas/paragangliomas produce noradrenaline and/or adrenaline. Those that produce dopamine are rare. We describe the distinguishing clinical features of dopamine-secreting phaeochromocytomas and paragangliomas from those that secrete noradrenaline/adrenaline and the impact on their management. We present a case of a dopamine-secreting paraganglioma from our institution and review 14 case reports of dopamine-secreting phaeochromocytomas/paragangliomas published between 1984 and 2008. As observed in the literature, 80% of the tumours were extra-adrenal. Most patients presented with non-specific symptoms or mass effect without the classical presentation of catecholamine excess. The majority were diagnosed with urinary or plasma dopamine. Five patients had malignant tumours and 12 patients underwent surgical resection of the primary tumours. Unlike noradrenaline/adrenaline-secreting phaeochromocytomas/paragangliomas, dopamine-secreting tumours lack a classical presentation, are extra-adrenal and have a higher malignant potential. A routine inclusion of urinary or plasma dopamine as part of catecholamine screening in all suspected phaeochromocytomas and paragangliomas is recommended.

Matched MeSH terms: Head and Neck Neoplasms/diagnosis

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