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Matsumoto Y, Kobayashi K, Eguchi K, Watanabe T, Sakai A, Omura G, Yoshimoto S. Surgical approach through the anterior scalene muscle resection for invasive tumours in the supraclavicular fossa (with video). Jpn J Clin Oncol 2024; 54:939-944. [PMID: 38693751 DOI: 10.1093/jjco/hyae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The supraclavicular fossa contains many vital organs to be preserved, such as the brachial plexus, subclavian artery and vertebral artery. Various surgical methods have been reported. However, no well-standardized surgical procedure has been established. METHODS Between 2010 and 2020, we performed 28 surgical treatments of the superior mediastinum and supraclavicular fossa. Of these, we retrospectively reviewed seven cases of supraclavicular invasion using a unified surgical technique in which the anterior scalene muscle was resected, and the inter-scalene triangle was approached. RESULTS We performed claviculectomy in four cases and a transmanubrial approach in three cases. In all cases, by resecting the anterior scalene muscle, the brachial plexus, subclavian artery and vertebral artery were preserved. There were no critical postoperative complications other than tracheostomy and lymphatic leakage. Median bleeding amount and operative time were 438 (range; 76-1144) ml and 328 (range; 246-615) minutes, respectively. CONCLUSIONS The anterior scalene muscle resection method might be a safe and standardized method for preserving the brachial plexus, subclavian artery and vertebral artery.
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Affiliation(s)
- Yoshifumi Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kohtaro Eguchi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takane Watanabe
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Azusa Sakai
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Go Omura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
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2
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Hanzalova I, Matter M. Peripheral lymphadenopathy of unknown origin in adults: a diagnostic approach emphasizing the malignancy hypothesis. Swiss Med Wkly 2024; 154:3549. [PMID: 39154257 DOI: 10.57187/s.3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024] Open
Abstract
The term lymphadenopathy refers to an abnormality in size, consistency or morphological aspect of one or several lymph nodes. Although lymphadenopathies are commonly observed in everyday clinical practice, the difficulty of differentiating benign and malignant disease may delay therapeutic approaches. The present review aims to update diagnostic algorithms in different clinical situations based on the currently available literature. A literature review was performed to assess current knowledge of and to update the diagnostic approach. A short clinical vignette was used as an example of a typical clinical presentation. This case of metastatic lymphadenopathy with incomplete patient history demonstrates how misleading such lymphadenopathy may be, leading to a delayed diagnosis and even a fatal outcome. Any lymphadenopathy persisting for more than 2 weeks should be considered suspicious and deserves further investigation. Precise clinical examination, meticulous history-taking and a search for associated symptomatology are still cornerstones for diagnosing the origin of the condition. The next diagnostic step depends on the anatomical region and the specific patient's situation. Imaging starts with ultrasound, while computed tomography (CT) and magnetic resonance imaging (MRI) allow assessment of the surrounding structures. If the diagnosis remains uncertain, tissue sampling and histological analyses should be performed. Except for head and neck loco-regional lymphadenopathy, there are no methodical guidelines for persistent lymphadenopathy. The present review clarifies several confusing and complex situations. The accuracy of fine needle aspiration cytology could be increased by using core needle biopsy with immunocytologic and flow cytometric methods. Notably, except in the head and neck area, open biopsy remains the best option when lymphoma is suspected or when inconclusive results of previous fine needle aspiration cytology or core needle biopsy are obtained. The incidence of malignant lymphadenopathy varies with its location and the various diagnostic strategies. In metastatic lymphadenopathy of unknown primary origin, European Society for Medical Oncology (ESMO) guidelines and modern methods like next-generation sequencing (NGS) may help to manage such complex cases.
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Affiliation(s)
- Ivana Hanzalova
- Department of Surgery, University Hospital and Lausanne University, Lausanne, Switzerland
| | - Maurice Matter
- Department of Surgery, University Hospital and Lausanne University, Lausanne, Switzerland
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3
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Zdilla MJ, Gross AR, Hajarat T, Vos JA. Bilateral Virchow nodes: an unusual finding of pulmonary small-cell neuroendocrine carcinoma metastasis. Autops Case Rep 2023; 13:e2023455. [PMID: 38034518 PMCID: PMC10688261 DOI: 10.4322/acr.2023.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/02/2023] [Indexed: 12/02/2023]
Abstract
An enlarged left-sided supraclavicular node is a signal node for cancer metastasis. In such a case, the enlarged lymph node is often referred to as a Virchow node. The left-sided nature of the node is due to the drainage of the thoracic duct. So, the enlargement of a Virchow node is typically associated with malignancies, including gastrointestinal, pulmonary, and genitourinary carcinomas, in addition to lymphomas. This report documents a particularly unusual finding: bilateral Virchow nodes, representing metastasis of small-cell neuroendocrine carcinoma.
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Affiliation(s)
- Matthew J. Zdilla
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Alexander R. Gross
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Tara Hajarat
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Jeffrey A. Vos
- West Virginia University School of Medicine, Department of Pathology, Anatomy, and Laboratory Medicine, Morgantown, West Virginia, USA
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4
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Meng Z, Zhu Y, Pang W, Tian J, Nie F, Wang K. MSMFN: An Ultrasound Based Multi-Step Modality Fusion Network for Identifying the Histologic Subtypes of Metastatic Cervical Lymphadenopathy. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:996-1008. [PMID: 36383594 DOI: 10.1109/tmi.2022.3222541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Identifying squamous cell carcinoma and adenocarcinoma subtypes of metastatic cervical lymphadenopathy (CLA) is critical for localizing the primary lesion and initiating timely therapy. B-mode ultrasound (BUS), color Doppler flow imaging (CDFI), ultrasound elastography (UE) and dynamic contrast-enhanced ultrasound provide effective tools for identification but synthesis of modality information is a challenge for clinicians. Therefore, based on deep learning, rationally fusing these modalities with clinical information to personalize the classification of metastatic CLA requires new explorations. In this paper, we propose Multi-step Modality Fusion Network (MSMFN) for multi-modal ultrasound fusion to identify histological subtypes of metastatic CLA. MSMFN can mine the unique features of each modality and fuse them in a hierarchical three-step process. Specifically, first, under the guidance of high-level BUS semantic feature maps, information in CDFI and UE is extracted by modality interaction, and the static imaging feature vector is obtained. Then, a self-supervised feature orthogonalization loss is introduced to help learn modality heterogeneity features while maintaining maximal task-consistent category distinguishability of modalities. Finally, six encoded clinical information are utilized to avoid prediction bias and improve prediction ability further. Our three-fold cross-validation experiments demonstrate that our method surpasses clinicians and other multi-modal fusion methods with an accuracy of 80.06%, a true-positive rate of 81.81%, and a true-negative rate of 80.00%. Our network provides a multi-modal ultrasound fusion framework that considers prior clinical knowledge and modality-specific characteristics. Our code will be available at: https://github.com/RichardSunnyMeng/MSMFN.
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5
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da Costa Vieira RA, de Araujo Silva I, de Souza Coelho RD, de Almeida Junior CR, de Almeida Santos Yamashita ME. Brachial plexus schwannoma mimicking advanced breast carcinoma. Breast Dis 2021; 39:109-113. [PMID: 32083563 DOI: 10.3233/bd-190432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Schwannoma is an extremely rare benign tumour of the peripheral nervous system; its association with breast cancer is sporadic, and its association with the brachial plexus is extremely rare. CASE DESCRIPTION The authors report a case of a patient with breast cancer associated with nodulation in the left supraclavicular fossa, and due to the clinical and radiological features, it was considered metastatic lymph node disease. The patient underwent neoadjuvant chemotherapy, with partial response of the breast. Surgical treatment included resection of the supraclavicular nodule, which was found to be a supraclavicular fossa schwannoma. The correct diagnosis, influences the radiotherapeutic planning. The unusual presentation led to diagnostic confusion in the present case, a fact that changed the breast treatment. CONCLUSION The best of our knowledge it is the third description of brachial plexus schwannoma associated with breast cancer and the first with a synchronous association. The knowledge of this pathology and its potential to alter treatment justify the reporting of the present case.
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Affiliation(s)
| | - Igor de Araujo Silva
- Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, São Paulo, Brazil
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6
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Mota S, Rodrigues CF, Moreira C. Radiologic confirmation of bilateral cervical ribs in an adolescent. Radiol Case Rep 2021; 16:798-800. [PMID: 33552328 PMCID: PMC7846893 DOI: 10.1016/j.radcr.2021.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022] Open
Abstract
A previously healthy 14-year-old girl presented to an unscheduled consultation with recent symptoms of myalgias, sore throat, and rhinorrhea. Her physical examination was unremarkable except for bilateral, firm supraclavicular masses. Concern for malignancy lead to investigation and the radiologic diagnosis of bilateral, asymptomatic cervical ribs was made.
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Affiliation(s)
- Sílvia Mota
- Pediatrics Department, Hospital de Braga, Braga, Portugal
| | | | - Carla Moreira
- Pediatrics Department, Hospital de Braga, Braga, Portugal
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7
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Pisani P, Airoldi M, Allais A, Aluffi Valletti P, Battista M, Benazzo M, Briatore R, Cacciola S, Cocuzza S, Colombo A, Conti B, Costanzo A, della Vecchia L, Denaro N, Fantozzi C, Galizia D, Garzaro M, Genta I, Iasi GA, Krengli M, Landolfo V, Lanza GV, Magnano M, Mancuso M, Maroldi R, Masini L, Merlano MC, Piemonte M, Pisani S, Prina-Mello A, Prioglio L, Rugiu MG, Scasso F, Serra A, Valente G, Zannetti M, Zigliani A. Metastatic disease in head & neck oncology. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2020; 40:S1-S86. [PMID: 32469009 PMCID: PMC7263073 DOI: 10.14639/0392-100x-suppl.1-40-2020] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.
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Affiliation(s)
- Paolo Pisani
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Mario Airoldi
- Medical Oncology, Città della Salute e della Scienza, Torino, Italy
| | | | - Paolo Aluffi Valletti
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | | | - Marco Benazzo
- SC Otorinolaringoiatria, Fondazione IRCCS Policlinico “S. Matteo”, Università di Pavia, Italy
| | | | | | - Salvatore Cocuzza
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Italy
| | - Andrea Colombo
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Bice Conti
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Laura della Vecchia
- Unit of Otorhinolaryngology General Hospital “Macchi”, ASST dei Settelaghi, Varese, Italy
| | - Nerina Denaro
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
| | | | - Danilo Galizia
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Massimiliano Garzaro
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | - Ida Genta
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Marco Krengli
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | | | - Giovanni Vittorio Lanza
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | | | - Maurizio Mancuso
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
| | - Laura Masini
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
| | - Marco Carlo Merlano
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Marco Piemonte
- ENT Unit, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Silvia Pisani
- Immunology and Transplantation Laboratory Fondazione IRCCS Policlinico “S. Matteo”, Pavia, Italy
| | - Adriele Prina-Mello
- LBCAM, Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin 8, Ireland
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland
| | - Luca Prioglio
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | | | - Felice Scasso
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | - Agostino Serra
- University of Catania, Italy
- G.B. Morgagni Foundation, Catania, Italy
| | - Guido Valente
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Micol Zannetti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Angelo Zigliani
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
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8
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Moore TA, Pham TD, Bui HT. Angioleiomyoma presenting as a lateral neck lump: a diagnostic dilemma. J Surg Case Rep 2020; 2020:rjaa021. [PMID: 32161638 PMCID: PMC7059895 DOI: 10.1093/jscr/rjaa021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 11/22/2022] Open
Abstract
Angioleiomyomas are defined as benign dermal or subcutaneous tumours consisting of smooth muscle cells arranged around vascular channels. Head and neck angioleiomyomas are rarely encountered as they usually occur in the extremities. We report a case of a 71-year-old male, who presented with a 3-month history of a painless lateral neck lump. Ultrasound and computed tomography scans localised the suspicious hypervascular tumour to the right supraclavicular fossa between the two heads of sternocleidomastoid muscle. He subsequently underwent an excisional biopsy, where histological analysis determined that the lateral neck mass was a venous subtype angioleiomyoma. To the best of our knowledge, this is only the third reported case of an angioleiomyoma in the supraclavicular fossa. Although supraclavicular masses are typically synonymous with malignancy, this case report highlights that angioleiomyoma should be considered as a differential diagnosis when investigating patients with a lateral neck lump.
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Affiliation(s)
- Tyson A Moore
- Department of Surgery, Western Health, Victoria, Australia
| | - Toan D Pham
- Department of Surgery, Western Health, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hai T Bui
- Department of Surgery, Western Health, Victoria, Australia
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9
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Geropoulos G, Mitsos S, Lampridis S, Hayward M, Scarci M, Panagiotopoulos N. Carcinoma of unknown primary abuts left clavicle: Case report and review of the literature. Int J Surg Case Rep 2020; 67:106-109. [PMID: 32058306 PMCID: PMC7016038 DOI: 10.1016/j.ijscr.2019.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/07/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Carcinoma of unknown primary clinical manifestations usually associated with head and neck region. Painless cervical Lymphadenopathy is the most common symptom of the disease. Laboratory tests usually do not identify the primary disease. Limited data exists about management and the role of surgery in carcinoma of unknown primary if a single neck mass exists without evidence of lymph node implication.
Introduction Carcinoma of unknown primary is a well-recognized clinical syndrome which accounts for the 3–5% of all the malignancies. Patients with carcinoma of unknown primary usually present with late stage disease without having identified the primary source of the tumour despite an extensive diagnostic work-up. Presentation of case A 60 years old male presented to the clinic complaining of a neck mass to the left lateral neck. Patient’s history was unremarkable without evidence of any malignant disease. Clinical and radiological examination revealed a cystic mass extending from the lower one third of the neck to the left clavicle causing periostal reaction. Mass biopsy and PET-CT was unspecific for the primary origin of the mass. However in the context of tumour immunohistochemistry, HPV status, neck location and basaloid cell differentiation, the tumour mass was considered as carcinoma of unknown primary with possible oropharyngeal primary location. The patient underwent surgical resection of the mass, left clavicle and the first rib. One year after the operation the patient is disease free. Discussion Although CUP usually presents with cervical lyphadenopathy, in our case there was no evidence of lymph node tissue infiltration in the neck region. Surgical resection of the mass showed that the location was extending within the cervical soft tissues and upper thorax. Taking into consideration the absence of lymphadenopathy this is an uncommon location of carcinoma of unknown primary in the neck. Conclusion This is an uncommon location of CUP with possible implications in survival and management.
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Affiliation(s)
- Georgios Geropoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK.
| | - Sofoklis Mitsos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Savvas Lampridis
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Martin Hayward
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Marco Scarci
- Thoracic Surgery Department, San Geraldo Hospital, Monza, Italy
| | - Nikolaos Panagiotopoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
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10
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Zdilla MJ, Aldawood AM, Plata A, Vos JA, Lambert HW. Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node. AUTOPSY AND CASE REPORTS 2019; 9:e2018053. [PMID: 30863728 PMCID: PMC6394356 DOI: 10.4322/acr.2018.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Matthew J Zdilla
- West Liberty University, Department of Natural Sciences & Mathematics and Graduate Health Sciences. West Liberty, West Virginia, USA.,West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA.,West Liberty University, Department of Graduate Health Sciences. West Liberty, West Virginia, USA
| | - Ali M Aldawood
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - Andrew Plata
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
| | - H Wayne Lambert
- West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA
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11
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Gastrointestinal Malignancy Presenting with a Virchow's Node in a Patient with Rothmund-Thomson Syndrome. Case Rep Genet 2018; 2018:7536832. [PMID: 30498607 PMCID: PMC6222232 DOI: 10.1155/2018/7536832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022] Open
Abstract
Rothmund-Thomson syndrome is a genetic disorder with characteristic findings in childhood as well as a predisposition to osteosarcoma, skin cancer, and hematological malignancy. We present the first reported case of duodenal malignancy in a patient with Rothmund-Thompson syndrome. An enlarged Virchow's node was noted and an advanced duodenal adenocarcinoma was diagnosed shortly thereafter. The features of Rothmund-Thomson syndrome are discussed, as well as current management and screening guidelines for duodenal adenocarcinoma.
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12
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Sato K, Thompson LDR, Miyai K, Kono T, Tsuda H. Ectopic Hamartomatous Thymoma: A Review Of The Literature With Report Of New Cases And Proposal Of A New Name: Biphenotypic Branchioma. Head Neck Pathol 2017; 12:202-209. [PMID: 28879635 PMCID: PMC5953876 DOI: 10.1007/s12105-017-0854-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022]
Abstract
Ectopic hamartomatous thymoma (EHT) is a rare benign neoplasm of the lower neck suggesting branchial origin. Despite use of the term thymoma in the nomenclature, there is no evidence of thymic origin or differentiation. It affects middle-aged adults with a remarkable male predominance. To date less than 80 cases have been reported in the English literature. We present here two additional cases of EHT. The first is a benign case in a 31-year-old man, showing typical histological features. The second is a malignant case in a 70-year-old woman, showing intraductal carcinoma arising in intimate association with an EHT. These cases are presented in the context of a review of cases reported in the English literature. The exact origin has not been identified, but is considered to be of branchial apparatus, creating a quandary about the best terminology. Recently, the designation "branchial anlage mixed tumor" or "thymic anlage tumor" were proposed, but do not quite reflect the true nature of the neoplasm. To avoid taxonomic confusion, international consensus on terminology is desired. As this entity is a neoplasm that shows dual mesoderm and endoderm derivation/differentiation, we propose a new name "biphenotypic branchioma."
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Affiliation(s)
- Kimiya Sato
- Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Lester D R Thompson
- Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA, 91367, USA
| | - Kosuke Miyai
- Department of Pathology, Japan Self Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Takako Kono
- Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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