Case summaRyA 70-year-old male presented with a swelling in the left lateral side of the neck of 1 month's duration. The swelling was progressive in nature and not associated with pain or fever initially, but subsequently the patient developed pain and difficulty in swallowing. The patient was a chronic smoker since 20 years who smoked 5 to 6 cigarettes per day. Local examinationInspection: A solitary left cervical swelling at level II measuring about 6x4 cm with smooth surface was seen.Palpation: Size-6x4cms, Borders-well made out, Consistencyhard, Mobile.Fine needle aspiration cytology of the left cervical lymph node showed metastatic carcinomatous deposits.Indirect laryngoscopy revealed an ulcero-proliferative growth in the nasopharynx. The extent of the growth could not be made out.A clinical diagnosis of nasopharyngeal malignancy was offered and the punch biopsy from the ulcero-proliferative growth in the nasopharynx was submitted for histopathological examination. By correlating the fine needle aspiration cytology findings in the left cervical lymph node and the histopathological findings in the nasopharyngeal growth, a final diagnosis of nasopharyngeal mucoepidermoid carcinoma with metastatic deposits in the left cervical lymph node was signed out. Following this report, the patient was immediately referred to a higher centre for further management and was lost to follow up. Pathology Section aBsTRaCTMucoepidermoid carcinomas mostly occur in the major salivary glands, the minor salivary glands of oral cavity and in the lacrimal glands. These tumours rarely occur in the sino-nasal tract. When they occur in the sino-nasal tract, the most frequent site is the maxillary antrum, followed by the nasal cavity, the nasopharynx and the ethmoidal sinuses. As per review of literature, nasopharyngeal mucoepidermoid carcinomas account for 0.6% of salivary gland tumours and 4.8% of mucoepidermoid carcinomas. Extensive literature search revealed 21 cases of nasopharyngeal mucoepidermoid carcinomas reported till date. These cases showed an age incidence ranging from 20 to 60 years with a female preponderance.In contrast to nasopharyngeal carcinomas, these tumours show low positivity rates for Ebstein-Barr virus serological test. Histochemical positivity for mucin may be demonstrated in the glandular and mucinous components of these tumours. High grade mucoepidermoid carcinoma of nasopharynx is treated with surgical excision combined with radiotherapy and is associated with poor survival. Therefore, early diagnosis and prompt treatment are of utmost importance.This case report highlights the rare occurrence of a high grade nasopharyngeal muco-epidermoid carcinoma in a 70-year-old male and is presented for its unusual occurrence in the nasopharynx which is the most infrequent location for this lesion.
Squamous cell carcinoma of external auditory canal is a rare entity. It is usually managed with surgery followed by adjuvant radiation therapy in locally advanced disease, whereas in early disease single modality of treatment is preferred. In this article, we report a patient with squamous cell carcinoma of external auditory canal, treated with radical radiation -combination of external beam therapy followed by brachytherapy boost. HDR brachytherapy was executed using stethoscope ear piece and single 6 Fr flexible brachytherapy catheter. Our idea is to highlight the technique and dosimetry of this procedure.
Case PresentationAdenoid Cystic Carcinomas (ACC) represents the most frequent carcinoma of the lacrimal gland with a percentage of 32% [1]. Usual Symptoms comprise, propoptosis, loss of vision, diplopia, epiphora, eye lid swelling and pain [2,3]. Local therapy as surgery or radiation therapy is complicated by the orbital anatomy involving the second, third and sixth cranial nerve and essential structures for ocular function as the lacrimal gland, external and internal muscles, lens and the retina [4]. The following case illustrates the interdisciplinary approach to a rare tumor entity and the considerations made for preserving the orbital structures functionally. PatientA 53 yrs -lady was evaluated for left eye proptosis for 6 months. Ophthalmic examination showed normal vision and a prominent tumor in the superior-temporal quadrant of the left orbit. MRI revealed, a left bulb protrusion due to a sharp demarcated tumor in the left upper quadrant (1.8* 0.7* 2.0 cm) with posterior extension to lateral rectus and left lateral wall of orbit was noticed and thought to be a pleomorphic adenoma (Figure 1). The patient underwent resection of mass by left lateral orbitotomy with osteotomy of left lateral orbital wall . Intraoperatively, the tumor was found to be superficial with extracapsular extension and was consequently removed, supposedly completely. Figure 1: MRI image showing left orbital mass lesion.Pathological examination revealed an ACC of the lacrimal gland . No evidence of perineural invasion and the resection margins were free. Subsequently, the carcinoma was staged as pT2, pNx, cMx [5]. C Kit -Positive in Immunohistochemistry
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