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Oprean CM, Segarceanu NA, Stan A, Suciu CS, Grujic D, Rivis IA, Dema ALC, Bredicean AC. Carcinomatous-like mastitis due to axillary lymphadenopathy in a case of nasopharyngeal carcinoma: A case report. Exp Ther Med 2021; 22:1026. [PMID: 34373712 PMCID: PMC8343883 DOI: 10.3892/etm.2021.10458] [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: 04/29/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a rare form of malignancy, accounting for 2% of all cancers of the head and neck in Europe. Axillary lymph node metastases are very rare in these cases. This is a case report of a 40-year-old premenopausal woman diagnosed in May 2015 with T1N2M0 stage III NPC, treated with induction chemotherapy, followed by chemo-radiotherapy. Post-therapeutic computed tomography (CT) scan showed partial response (PR) on the primary tumor and complete response (CR) on the latero-cervical lymph nodes. In 2017, our patient developed left carcinomatous-like mastitis with axillary lymphadenopathy. This raised suspicions of a carcinomatous mastitis. The pathology report with immunohistochemistry (IHC) of the third biopsy highlighted axillary metastasis of a non-keratinizing squamous cell carcinoma (NSCC). There are very few references in the literature regarding axillary metastases from squamous cell carcinoma of the head and neck (HNSCC). As far as we know, this is the first case report of mastitis due to NPC. To conclude, treatment consisted of two surgical excisions of axillary lymphadenopathy associated with local radiotherapy and chemotherapy (neo-adjuvant, adjuvant). The second surgery, performed after radiotherapy, required plastic surgery. A psychiatric evaluation was necessary, revealing a reactive anxiety disorder. This case required multidisciplinary management, where oncology, plastic surgery, pathology and psychiatric specialists collaborated in deciding the therapeutic approach.
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Affiliation(s)
- Cristina Marinela Oprean
- Discipline of Morpho-Pathology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania.,Department of Oncology, OncoHelp Hospital, 300239 Timisoara, Romania.,Department of Oncology, Oncomed Outpatient Unit, 300239 Timisoara, Romania
| | - Nusa Alina Segarceanu
- Department of Oncology, OncoHelp Hospital, 300239 Timisoara, Romania.,Department of Oncology, Oncomed Outpatient Unit, 300239 Timisoara, Romania
| | - Alexandra Stan
- Department of Oncology, Emergency City Hospital, 300254 Timisoara, Romania
| | - Cristian Silviu Suciu
- Discipline of Histology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Daciana Grujic
- Department of Plastic and Reconstructive Surgery, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania.,Clinic of Burns, Plastic and Reconstructive Surgery, 'Pius Branzeu' Emergency County Hospital, 300041 Timisoara, Romania
| | - Ioana Alexandra Rivis
- Neurosciences Department, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,NEUROPSY-COG Center for Cognitive Research in Neuropsychiatric Pathology, Neurosciences Department, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Alis Liliana Carmen Dema
- ANAPATMOL Research Center, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Ana Cristina Bredicean
- NEUROPSY-COG Center for Cognitive Research in Neuropsychiatric Pathology, Neurosciences Department, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania.,Psychiatry Compartment, 'Dr Victor Popescu' Emergency Hospital, 300080 Timisoara, Romania
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Alessandro S, Magremanne M, Marbaix E, Reychler H, Mahy P. Axillary lymph node metastasis in second oropharyngeal cancer. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:160-163. [PMID: 30391374 DOI: 10.1016/j.jormas.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/17/2018] [Accepted: 10/21/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The risk of metastasizing in axillary lymph node is occasional in the head and neck cancers. This pattern of spread is difficult to explain and totally unpredictable even for these lymphophilic cancers. OBSERVATION A 72-year-old patient benefited, 11 years ago, of surgical oncology care associated with adjuvant radiotherapy for squamous cell carcinoma of the left floor of the mouth (pT4 pN2b M0). He presented a second primary malignancy at the right oropharyngeal level. Pet CT revealed a right infraclinic axillary metastasis. The metastatic origin was confirmed by pathological analysis. DISCUSSION The current management of head and neck cancers is based on the histological pattern of infiltration, the size of the primary tumor and the pattern of metastasizing lymph nodes and potential distant spreading. Current tests allow us to diagnose most distant metastases even outside the usual area of lymphatic drainage. Involvement of axillary lymph node, probably through retrograde lymphatic spreading is not so rare in recurrences of oropharyngeal cancer (T3-T4, N2…) as we have observed in the literature. In this review, we raise some degree of similarity between such oncological progression and factors related to this aberrant spreading.
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Affiliation(s)
- S Alessandro
- Service de stomatologie et chirurgie maxillo-faciale, Cliniques universitaires Saint-Luc, UCL, avenue Hippocrate 10, 1200 Bruxelles, Belgium.
| | - M Magremanne
- Service de stomatologie et chirurgie maxillo-faciale, Cliniques universitaires Saint-Luc, UCL, avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - E Marbaix
- Service d'anatomie pathologique, Cliniques universitaires Saint-Luc, UCL, avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - H Reychler
- Service de stomatologie et chirurgie maxillo-faciale, Cliniques universitaires Saint-Luc, UCL, avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - P Mahy
- Service de stomatologie et chirurgie maxillo-faciale, Cliniques universitaires Saint-Luc, UCL, avenue Hippocrate 10, 1200 Bruxelles, Belgium
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Qiu J, Peng S, Yang A, Ma Y, Han L, Cheng MA, Farmer E, Hung CF, Wu TC. Intramuscular vaccination targeting mucosal tumor draining lymph node enhances integrins-mediated CD8+ T cell infiltration to control mucosal tumor growth. Oncoimmunology 2018; 7:e1463946. [PMID: 30221059 PMCID: PMC6136882 DOI: 10.1080/2162402x.2018.1463946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 10/16/2022] Open
Abstract
Purpose: Mucosal immunization is suggested to be crucial for controlling tumors in the mucosal region; however, therapeutic DNA vaccination with electroporation in various mucosal sites has yet to become clinically adaptable. Since tumor-draining lymph nodes (tdLNs) have been suggested as immune-educated sites that can be utilized to mount a potent antitumor immune response, we examined whether intramuscular DNA vaccination with electroporation at sites that target the mucosal tdLNs could elicit mucosal immune response to restrict tumor growth. Experimental Design: The efficacy and mechanism of intramuscular administration of a therapeutic DNA vaccine with electroporation at different sites was examined by lymphocyte analysis, tumor growth, mouse survival, as well as integrin expression, in mice bearing orthotopic HPV16 E6/E7+ syngeneic TC-1 tumors in various mucosal areas. Results: While provoking comparable systemic CD8+ T cell responses, intramuscular hind leg vaccination generated stronger responses in cervicovaginal-draining LNs to control cervicovaginal tumors, whereas intramuscular front leg vaccination generated stronger responses in oral-draining LNs to control buccal tumors. Surgical removal of tdLNs abolished the antitumor effects of therapeutic vaccination. Mucosal-tdLN-targeted intramuscular vaccination induced the expression of mucosal-homing integrins LPAM-1 and CD49a by tumor-specific CD8+ T cells in the tdLNs. Inhibition of these integrins abolished the therapeutic effects of vaccination and the infiltration of tumor-specific CD8+ T cells into mucosal tumors. Conclusions: Our findings demonstrate that tumor draining lymph nodes targeted intramuscular immunization can effectively control mucosal tumors, which represents a readily adaptable strategy for treating mucosal cancers in humans.
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Affiliation(s)
- Jin Qiu
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Shiwen Peng
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Andrew Yang
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Ying Ma
- Department of Gynecology and Obstetrics, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong province, China; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Liping Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Max A. Cheng
- Department of Pathology; Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Emily Farmer
- Department of Pathology; Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Chien-Fu Hung
- Department of Pathology and Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - T.-C. Wu
- Departments of Pathology, Department of Obstetrics and Gynecology, Department of Molecular Microbiology and Immunology, and Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, UnitedStates
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Abstract
Oral squamous cell carcinoma (OSCC) has been estimated to be the sixth most common cancer worldwide. The distant metastasis plays a critical role in the management and prognosis in oral cancer patients. Regarding the distant metastasis from the oral cancer, the hypopharynx is the most common primary site, followed by the base of tongue and anterior tongue. The present review article analyzes the characteristics of the distant metastases from the oral cavity from 1937 to 2015.
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Affiliation(s)
- Soussan Irani
- Department of Oral Pathology, Dental Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
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Axillary nodal metastasis at primary presentation of an oropharyngeal primary carcinoma: a case report and review of the literature. J Med Case Rep 2009; 3:7230. [PMID: 19830142 PMCID: PMC2737770 DOI: 10.4076/1752-1947-3-7230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 01/22/2009] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Axillary nodal metastasis is very rare in head and neck squamous cell carcinoma. The few cases reported in the literature all involve patients who have previously undergone either neck dissection alone, or neck dissection and radiotherapy to the neck, and subsequently develop delayed recurrences of disease, with axillary nodal involvement. CASE PRESENTATION We present the case of a 62-year-old man of Cape Malay ethnicity, who presented with an oropharyngeal squamous cell carcinoma, and cervical and axillary nodal metastasis at primary presentation. CONCLUSION Whilst previous reports in the literature suggest routine examination of the axilla is advisable in patients with previously treated neck cancer and recurrence of head and neck cancer, we propose that the axilla should be routinely examined in new cases, particularly when there is involvement of the level 5 nodes.
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Jones AS, Tandon S, Helliwell TR, Husband DJ, Jones TM. Survival of patients with neck recurrence following radical neck dissection: Utility of a second neck dissection? Head Neck 2008; 30:1514-22. [DOI: 10.1002/hed.20860] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Arosarena OA, Madsen M, Haug R. Special considerations with floor of mouth and tongue cancer. Oral Maxillofac Surg Clin North Am 2007; 18:521-31. [PMID: 18088850 DOI: 10.1016/j.coms.2006.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vahtsevanos K, Ntomouchtsis A, Andreadis C, Patrikidou A, Karakinaris G, Mangoudi D, Papanastasiou G, Antoniades K. Distant bone metastases from carcinoma of the lip: a report of four cases. Int J Oral Maxillofac Surg 2007; 36:180-5. [PMID: 17223312 DOI: 10.1016/j.ijom.2006.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 06/08/2006] [Accepted: 07/11/2006] [Indexed: 11/15/2022]
Abstract
The lip is estimated to be the most frequent location for carcinoma of the oral cavity. It occurs more frequently in men, especially those with a history of exposure to sunlight. Despite the usually effective management, regional and occasionally distant metastases do occur, especially in advanced stages. In this retrospective analysis of patients with labial carcinoma presenting with distant bone metastases in 1995-2003, the extremely limited number of patients did not allow for multivariate data analysis. From a cohort of 415 patients presenting with lip lesions, 186 cases were diagnosed as carcinoma and managed accordingly. Four patients (2.14%) showed distant bone metastases, one with concurrent axillary node metastasis. Patient demographics, tumour characteristics, case management and survival were evaluated. The distant metastasis patients were of clinical stages II-IV; initial management was wide local excision with reconstruction for all cases, with one undergoing concurrent neck dissection and one adjuvant radiotherapy. Time for distant bone metastasis was 9-21 months, subsequent survival 3-14 months and overall survival 13-35 months. Distant metastases from labial carcinoma are rare, not exceeding 2%. Metastasis to bone and axillary lymph nodes is exceptionally rare and can be attributed to either inadequate initial management or aggressive tumour behaviour.
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Affiliation(s)
- K Vahtsevanos
- Department of Maxillofacial Surgical Oncology, Theagenio Cancer Hospital, Thessaloniki, Greece. vahtsevk@otenet,gr
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