Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically — a Troisier sign. The VN is of profound clinical importance; however, there have been few studies of its regional anatomical relationships. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Recognition of the Troisier sign/VN is of great clinical importance. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered.
Background
Tumor‐specific molecular imaging in head and neck squamous cell carcinoma (HNSCC) is not well established. Somatostatin receptors (SSTRs) are found in solid tumors, including HNSCC. 68Ga‐DOTATATE, a commercially available radionuclide that binds SSTRs, may have utility in imaging HNSCC.
Methods
Patients with HNSCC received pretreatment imaging with 18F‐FDG‐PET/CT and 68Ga‐DOTATATE. Imaging was compared for concordance. When available, surgical resection specimens were compared to pretreatment imaging findings. Historic HNSCC tumor specimens were assessed for both SSTR and p16/human papilloma virus (HPV) expression.
Results
Twenty patients were imaged. Fifteen had oropharyngeal cancer. Primary tumor site was concordant between imaging modalities for all patients. One of 45 lymph nodes was discordant. Retrospective specimen review showed a significant correlation with SSTR expression and HPV/p16 expression. No adverse events occurred.
Conclusions
68Ga‐DOTATATE imaging is safe and effective in HNSCC. SSTR expression may be increased in HPV‐mediated tumors. Targeted therapies to SSTR should be explored.
Interprofessional collaboration between anatomists and pathologists is important, yet poses unique workflow challenges. Therefore, this report details a successful workflow example of a case of pulmonary adenocarcinoma metastasizing to a Virchow node wherein anatomists and pathologists collaborated in a manner that was both streamlined and effective. Essentially, gross pathology was identified in a gross anatomy laboratory, and an anatomist forwarded a description of these findings to the director of pathology residents. Next, the director of pathology residents forwarded basic details of gross anatomical findings to pathology residents while asking for resident participation based upon professional interests. The interested residents then contacted the anatomist, who, in turn, walked the residents through the gross anatomical findings in the dissection facilities. The residents resected the pathological tissues and then provided the anatomist with a written histopathological assessment that was confirmed by a seasoned pathologist. The insights of both the anatomists and pathologists led to successful description of the case with a robustness that either party would not have been able to complete on their own. This collaborative project led to a publication containing improved descriptions of clinically important findings arising from gross anatomy laboratories, and the effectiveness of the described workflow between anatomists, pathology residents, and pathologists will increase the collaborative output of all involved parties in future research projects and variant anatomical discoveries.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Patient: Male, 81
Final Diagnosis: Mantle cell lymphoma
Symptoms: Dificulty in swallowing and pain in the right ear
Medication: —
Clinical Procedure: Otorhinolaryngology panendoscopy • biopsy of the tumors
Specialty: Otolaryngology
Objective:
Rare disease
Background:
Radiation, specifically ionizing radiation, causes broad-spectrum gene damage, including double-strand DNA breaks, single DNA strand breaks, cross links, and individual base lesions, thus causing chromosomal translocations, deletions, point mutations, and, consequently, various types of cancer. Radiation also causes genomic instability in cells, which enhances the rate of mutations in the descendants of the irradiated cell after many generations of normal replications.
Case Report:
We report the first case of mantle cell lymphoma of the torus tubarius, and the first CD10-positive mantle cell lymphoma of the Waldeyer’s ring. Mantle cell lymphoma appeared 65 years after treatment of chronic sinusitis with nasopharyngeal radium irradiation.
Conclusions:
On the basis of the medical literature about atomic bomb survivors, nuclear plant workers, and radiologists exposed to radiation, and our case, we conclude that radiation can, in a very small percentage of exposed individuals, cause non-Hodgkin lymphoma: in 0.24% of atomic bomb survivors and in at least 0.13% of the patients treated with nasopharyngeal radium irradiation.
Non-Hodgkin lymphoma can occur many decades after radiation exposure, and individuals treated with nasopharyngeal radium irradiation, usually in their childhood, need continuing follow-up.
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