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Elyes M, Heesen P, Schelling G, Bode-Lesniewska B, Studer G, Fuchs B. Enhancing Healthcare for Sarcoma Patients: Lessons from a Diagnostic Pathway Efficiency Analysis. Cancers (Basel) 2023; 15:4892. [PMID: 37835586 PMCID: PMC10571532 DOI: 10.3390/cancers15194892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland's healthcare system, Europe's costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).
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Affiliation(s)
- Maria Elyes
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | - Philip Heesen
- University Hospital USZ, Sarcoma Servuce, University of Zurich, 8000 Zurich, Switzerland
| | - Georg Schelling
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | | | - Gabriela Studer
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | - Bruno Fuchs
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
- University Hospital USZ, Sarcoma Servuce, University of Zurich, 8000 Zurich, Switzerland
- Kantonsspital Winterthur, Sarcoma Service, 8400 Winterthur, Switzerland
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Halliday E, Wooles N, Grainger J. Fifteen-minute consultation: A structured approach to the assessment of a child with earache. Arch Dis Child Educ Pract Ed 2023; 108:2-9. [PMID: 34580153 DOI: 10.1136/archdischild-2021-322697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023]
Abstract
Earache, or otalgia, in children is common. Diagnosis can be challenging due to the range of causes. Assessment involves a thorough history and examination. Identification of associated otological symptoms, including discharge, hearing loss, vertigo and facial nerve weakness, is helpful and can aid diagnosis. Examination should involve looking at the external ear, otoscopy to assess the ear canal and tympanic membrane and documentation of facial nerve function. If otological examination is normal, further examination looking for non-otological causes may be guided by the history. Investigations are often unnecessary but may include blood tests, audiology and imaging. Most otalgia is caused by an acute infection, which is self-limiting and can be managed in the community. However, ear, nose and throat (ENT) advice and input may be required for systemically unwell children or those who fail to improve despite appropriate medical therapy.
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Affiliation(s)
- Edwin Halliday
- Department of Otolaryngology/Head & Neck Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Nicola Wooles
- Department of Otolaryngology/Head & Neck Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Joe Grainger
- Department of Otolaryngology/Head & Neck Surgery, Birmingham Children's Hospital, Birmingham, UK
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3
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Soomers V, Husson O, Young R, Desar I, Van der Graaf W. The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes. ESMO Open 2021; 5:S2059-7029(20)30008-9. [PMID: 32079621 PMCID: PMC7046415 DOI: 10.1136/esmoopen-2019-000592] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 12/27/2022] Open
Abstract
Sarcomas are rare and heterogeneous mesenchymal tumours of soft tissue or bone, making them prone to late diagnosis. In other malignancies, early diagnosis has an impact on stage of disease, complexity of therapeutic procedures, survival and health-related quality of life (HRQoL). Little is known about what length of diagnostic interval should be considered as delay in patients with bone (BS) or soft tissue sarcomas (STS). To quantify total interval (defined as time from first symptom to histological diagnosis) and its components, identify contributing factors to its length and determine the impact on patients’ outcome in terms of mortality and HRQoL. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-six articles out of 2310 met the predefined inclusion criteria. Total intervals, varied broadly; 9–120.4 weeks for BS and 4.3–614.9 weeks for STS. Older age and no initial radiological examinations were contributing factors for a long interval in BS, while in STS results were conflicting. The impact of length of total interval on clinical outcomes in terms of survival and morbidity remains ambiguous; no clear relation could be identified for both BS and STS. No study examined the impact on HRQoL. The length of total interval is variable in BS as well as STS. Its effect on outcomes is contradictory. There is no definition of a clinically relevant cut-off point that discriminates between a short or long total interval. Prospero: CRD42017062492.
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Affiliation(s)
- Vicky Soomers
- Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Olga Husson
- Institute of Cancer Research, London, London, UK.,Psychosocial research and epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Robin Young
- Medical Oncology, Weston Park Hospital, Sheffield, Sheffield, UK
| | - Ingrid Desar
- Medical Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Winette Van der Graaf
- Medical Oncology, Antoni van Leewenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands.,Medical Oncology, Radboudumc, Nijmegen, The Netherlands
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Wang GH, Shen HP, Chu ZM, Shen J. Adult rhabdomyosarcoma originating in the temporal muscle, invading the skull and meninges: A case report. World J Clin Cases 2021; 9:4866-4872. [PMID: 34222460 PMCID: PMC8223841 DOI: 10.12998/wjcc.v9.i18.4866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/13/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is a rare malignant tumor of mesenchymal origin that mainly affects children. Spindle cell/sclerosing RMS (SSRMS) is even rarer. It is a new subtype that was added to the World Health Organization disease classification in 2013. To the best of our knowledge, this is the first reported case of adult SSRMS disease classification originating in the temporal muscle.
CASE SUMMARY SSRMS originating in the temporal muscle of a male adult enlarged rapidly, destroyed the skull, and invaded the meninges. The tumor was completely removed, and the postoperative pathological diagnosis was SSRMS. Postoperative recovery was good and chemotherapy and radiotherapy were given after the operation. Followed up for 3 mo, no tumor recurred.
CONCLUSION RMS is one of the differential diagnoses for head soft tissue tumors with short-term enlargement and skull infiltration. Preoperative computed tomography or magnetic resonance imaging is necessary for early detection of tumor invasion of the skull and brain tissue.
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Affiliation(s)
- Geng-Huan Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - He-Ping Shen
- Department of Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zheng-Min Chu
- Department of Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jian Shen
- Department of Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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Weiss NM. Rare Diseases of the Middle Ear and Lateral Skull Base. Laryngorhinootologie 2021; 100:S1-S30. [PMID: 34352901 PMCID: PMC8354576 DOI: 10.1055/a-1347-4171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Otalgia, otorrhea and hearing loss are the most common ear-related symptoms that lead to the consultation of an otolaryngologist. Furthermore, balance disorders and affections of the cranial nerve function may play a role in the consultation. In large academic centres, but also in primary care, the identification of rare diseases of the middle ear and the lateral skull base is essential, as these diseases often require interdisciplinary approaches to establish the correct diagnosis and to initiate safe and adequate treatments. This review provides an overview of rare bone, neoplastic, haematological, autoimmunological and infectious disorders as well as malformations that may manifest in the middle ear and the lateral skull base. Knowledge of rare disorders is an essential factor ensuring the quality of patient care, in particular surgical procedures. Notably, in untypical, complicated, and prolonged disease courses, rare differential diagnoses need to be considered.
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Affiliation(s)
- Nora M. Weiss
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie
„Otto Körner“ der Universitätsmedizin Rostock,
Deutschland
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Zubir FS, Saniasiaya J, Abdul Gani H. Aural polyp with facial asymmetry in an unfortunate infant. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2021; 16:133-135. [PMID: 33948154 PMCID: PMC8088741 DOI: 10.51866/cr1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Temporal bone rhabdomyosarcoma is an aggressive entity that simulates chronic otitis ear infection. It is the most common soft tissue sarcoma amongst pediatric patients. Herein, we would like to report a case of temporal bone rhabdomyosarcoma involving a 2-year-old boy who presented with a one-month history of otorrhea with facial asymmetry. Early treatment led to remission of this severe neoplasm.
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Affiliation(s)
- Farah Syahida Zubir
- Department of Otorhinolaryngology, Hospital Tuanku Jaáfar, Seremban, Negeri Sembilan, Malaysia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Haslinda Abdul Gani
- Department of Otorhinolaryngology, Hospital Tuanku Jaafar, Seremban Negeri Sembilan, Malaysia
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Samara A, Herrmann S, Ditzler MG, Raj KM, Orlowski HLP, Eldaya RW. External Ear Diseases: A Comprehensive Review of the Pathologies With Neuroradiological Considerations. Curr Probl Diagn Radiol 2021; 51:250-261. [PMID: 33485754 DOI: 10.1067/j.cpradiol.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/13/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
The peripheral auditory system is subdivided into 3 compartments: the external, middle, and inner ear. Historically, the middle and inner ear have garnered more attention in the imaging literature, due to their intricate anatomy and complexity of pathologies. The external ear, however, has attained less recognition given its relatively straightforward anatomy and convenience of direct visual examination. The continued advancement in computed tomography and magnetic resonance imaging has expanded the role of radiology in the evaluation of the external ear lesions. The purpose of this article is to offer a comprehensive review of external ear pathologies, including congenital, inflammatory, infectious, traumatic, neoplastic, and rare disease entities and their imaging findings.
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Affiliation(s)
- Amjad Samara
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Stephen Herrmann
- Department of Radiology, Houston Methodist Hospital, Houston, TX
| | | | - Karuna M Raj
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Hilary L P Orlowski
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Rami W Eldaya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
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Roubaud MJC, Prevot J, Leclere JC, Mistretta C, Mornet E, Marianowski R. Management of neonatal retro-auricular embryonal rhabdomyosarcoma - Case report. Int J Surg Case Rep 2020; 75:322-326. [PMID: 32980702 PMCID: PMC7522586 DOI: 10.1016/j.ijscr.2020.09.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022] Open
Abstract
RMS is a fast-growing malignant and aggressive tumor originating from skeletal muscle. Diagnosis can be performed with CT-scan or MRI and confirmed by biopsy. The treatment is based on chemotherapy followed by radiotherapy or surgical resection.
Introduction Rhabdomyosarcoma (RMS) arises from mesenchymal cells committed to skeletal muscle. It is the most frequent soft-tissue sarcoma in children and makes up 5% of all pediatric malignant tumors. In this population, there are two main histological forms, which are the embryonal or the alveolar RMS. The retro auricular location is extremely rare. We present 2 cases of children with left retro-auricular RMS occurring at a very early stage of post natal development. Case reports Two children were included in the RMS 2005 Protocol. The first child, aged 5-days, was managed by surgical resection in two steps after a previous incomplete resection which was followed by 8 chemotherapy cycle. The second, aged 3-days, was managed by surgical resection of the tumor bed, completed by 8 chemotherapy cycle. On regular follow up for over 6 years after the diagnosis, both patients are free of recurrence. Discussion RMS is a fast-growing malignant and aggressive tumor originating from skeletal muscle. It occurs in the first decade of life and is associated with genetic conditions. With an unusual clinical presentation and anatomical location, both benign and malignant tumors can be suspected. Diagnosis can be performed with CT-scan or MRI and confirmed by biopsy. The treatment is based on chemotherapy followed by radiotherapy or surgical resection. In our two patients, the treatment program achieved complete disease control, with good prognosis especially because of anatomical location as well as early diagnosis.
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Affiliation(s)
| | - Julien Prevot
- CHRU de Brest, Department of Otolaryngology, Head & Neck Surgery, Brest, France
| | | | - Charlotte Mistretta
- CHRU de Brest, Department of Otolaryngology, Head & Neck Surgery, Brest, France
| | - Emmanuel Mornet
- CHRU de Brest, Department of Otolaryngology, Head & Neck Surgery, Brest, France
| | - Rémi Marianowski
- CHRU de Brest, Department of Otolaryngology, Head & Neck Surgery, Brest, France
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Coça KL, Bergmann A, de Angelis EC, Ferman S, Ribeiro MG. Incidence and risk factors of communication, swallowing, and orofacial myofunctional disorders in children and adolescents with cancer and benign neoplasms. J Pediatr Rehabil Med 2020; 13:25-35. [PMID: 32176665 DOI: 10.3233/prm-180576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe the incidence and risk factors of communication, swallowing, and orofacial myofunctional disorders in a cohort of children and adolescents with cancer and benign neoplasms. METHODS A prospective cohort study conducted with children aged ⩾ 2 years and adolescents of both genders admitted at the Pediatric Oncology Department of the Instituto Nacional de Câncer (INCA) between March 2014 and April 2015. Study participants were submitted to a Speech-Language Pathology (SLP) assessment at three different times: (T1) at hospital admission; (T2) six months after admission; (T3) one year after admission. RESULTS One hundred and sixty individuals were evaluated. At the time of hospital admission, 68 individuals (42.5%) presented with some type of SLP disorder. After one year of follow-up, 22.8% of the patients had developed new impairments. The occurrence of new speech-language disorders had a statistically significant association with the tumor site. In the risk analysis for the development of speech-language disorders with respect to the primary tumor site, compared to other sites, the central nervous system (CNS) tumor group was 8.29 times more likely to present some new alterations, while the head and neck (HN) tumor group had a 10.36-fold higher risk. CONCLUSION An incidence of 22.8% for communication, swallowing, and orofacial myofunctional disorders was observed. The development of these disorders was greater in individuals with tumors in the CNS and in the HN region.
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Affiliation(s)
- Kaliani Lima Coça
- Section of Speech-Language Pathology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil
| | - Anke Bergmann
- Molecular Carcinogenesis Program, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | | | - Sima Ferman
- Pediatric Oncology Service, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
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Hayes SM, Biggs TC, Bird JH, Hellier WP. Rhabdomyosarcoma of the middle ear cavity presenting with Horner's syndrome. Ann R Coll Surg Engl 2018. [PMID: 30286657 DOI: 10.1308/rcsann.2018.0157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rhabdomyosarcoma is a rare malignant tumour of striated muscle accounting for 3% of all primary soft tissue tumours of the middle ear cavity. We describe a unique case of a rhabdomyosarcoma of the middle ear cavity in a four-year-old boy, presenting as an otherwise asymptomatic ipsilateral Horner's syndrome. This case involved tumour erosion through the tensor tympani semicanal, accessing the carotid canal and the sympathetic plexus running through it. This child was treated successfully with chemotherapy and proton beam therapy, and remains disease free at six years of follow-up. This case highlights the importance of investigating patients with non-resolving ear infections, polyps or granulation tissue.
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Affiliation(s)
- S M Hayes
- Portsmouth Hospitals NHS Foundation Trust , Portsmouth , UK
| | - T C Biggs
- University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - J H Bird
- Poole Hospital NHS Foundation Trust , Poole , UK
| | - W P Hellier
- University Hospital Southampton NHS Foundation Trust , Southampton , UK
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13
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Coça KL, Bergmann A, Ferman S, Angelis ECD, Ribeiro MG. Prevalence of communication, swallowing and orofacial myofunctional disorders in children and adolescents at the time of admission at a cancer hospital. Codas 2018. [PMID: 29513872 DOI: 10.1590/2317-1782/20182017123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Describe the prevalence of communication, swallowing and orofacial myofunctional disorders in a group of children and adolescents at the time of registration at a cancer hospital. METHODS A cross-sectional study conducted with children aged ≥2 and adolescents, of both genders, admitted to the Pediatric Oncology Section of the Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) from March 2014 to April 2015 for investigation and/or treatment of solid tumors. A protocol was used to record the sociodemographic and clinical information and findings of the speech-language pathology clinical evaluation, which included aspects of the oral sensorimotor system, swallowing, speech, language, voice, and hearing. RESULTS Eighty-eight children/adolescents (41.3%) presented some type of speech-language disorder. The most frequent speech-language disorders were orofacial myofunctional disorder, dysphonia, and language impairments, whereas the less frequent ones were dysacusis, tongue paralysis, and trismus. Site of the lesion was the clinical variable that presented statistically significant correlation with presence of speech-language disorders. CONCLUSION High prevalence of speech-language disorders was observed in children and adolescents at the time of admission at a cancer hospital. Occurrence of speech-language disorders was higher in participants with lesions in the central nervous system and in the head and neck region.
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Affiliation(s)
- Kaliani Lima Coça
- Setor de Fonoaudiologia, Instituto Nacional de Câncer José de Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ), Brasil.,Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ), Brasil
| | - Anke Bergmann
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer José de Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ), Brasil
| | - Sima Ferman
- Serviço de Oncologia Pediátrica, Instituto Nacional de Câncer José de Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ), Brasil
| | | | - Márcia Gonçalves Ribeiro
- Departamento de Pediatria, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ), Brasil
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Ng SY, Goh BS. A Toddler with Rhabdomyosarcoma Presenting as Acute Otitis Media with Mastoid Abscess. Chin Med J (Engl) 2016; 129:1249-50. [PMID: 27174338 PMCID: PMC4878175 DOI: 10.4103/0366-6999.181973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sze Yin Ng
- Department of Otorhinolaryngology, Penang General Hospital, 10450 Georgetown, Pulau Pinang; Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Bee See Goh
- Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur; Institute of Ear, Hearing and Speech (Institute-HEARS), Universiti Kebangsaan Malaysia, Jalan Temerloh, 56000 Cheras, Kuala Lumpur, Malaysia
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Chevallier KM, Wiggins RH, Quinn NA, Gurgel RK. Differentiating Pediatric Rhabdomyosarcoma and Langerhans Cell Histiocytosis of the Temporal Bone by Imaging Appearance. AJNR Am J Neuroradiol 2016; 37:1185-9. [PMID: 26869468 DOI: 10.3174/ajnr.a4676] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/30/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Rhabdomyosarcoma and Langerhans cell histiocytosis are malignant lesions that can affect the skull base with similar radiographic characteristics on CT and MR imaging. We hypothesized that location within the temporal bone determined radiographically can provide useful adjunctive information in differentiating these distinct neoplasms. MATERIALS AND METHODS We identified patients with Langerhans cell histiocytosis and rhabdomyosarcoma by using an imaging data base and International Classification of Diseases, Ninth Revision codes at a tertiary care academic medical center. Cross-sectional images were reviewed by a neurotologist and neuroradiologist, who evaluated the location of the lesions and scored each subsite-middle ear, mastoid, petrous apex, retrosigmoid/posterior fossa-on a scale of 0 (no involvement), 1 (partial), or 2 (complete involvement). RESULTS We identified 12 patients representing 14 cases of Langerhans cell histiocytosis, and 9 patients representing 9 cases of rhabdomyosarcoma. For patients with Langerhans cell histiocytosis, mastoid involvement was rated 23/28 (82%) compared with 6/18 (33%) with rhabdomyosarcoma (P = .001). Langerhans cell histiocytosis was present in only the anterior portion of the temporal bone (petrous apex and middle ear) in 1 case (7.1%) and in the anterior portion of the temporal bone only in 5/9 (55%) cases of rhabdomyosarcoma (P = .018). The cortical bone was more commonly involved in Langerhans cell histiocytosis, 11/28 (39%) of cases compared with 2/18 (11%) cases in rhabdomyosarcoma (P < .05). CONCLUSIONS These results indicate that lesions involving only the anterior portion of the temporal bone (petrous apex and middle ear) are more likely to be rhabdomyosarcoma. Lesions involving the mastoid are more likely to be Langerhans cell histiocytosis. This difference in primary location may be helpful in predicting the pathology of these lesions on the basis of imaging.
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Affiliation(s)
- K M Chevallier
- From the Division of Otolaryngology, Head and Neck Surgery (K.M.C. R.H.W., N.Q., R.K.G.), University of Utah, Salt Lake City, Utah
| | - R H Wiggins
- From the Division of Otolaryngology, Head and Neck Surgery (K.M.C. R.H.W., N.Q., R.K.G.), University of Utah, Salt Lake City, Utah Department of Radiology (R.H.W.), University of Utah Hospital, Salt Lake City, Utah
| | - N A Quinn
- From the Division of Otolaryngology, Head and Neck Surgery (K.M.C. R.H.W., N.Q., R.K.G.), University of Utah, Salt Lake City, Utah
| | - R K Gurgel
- From the Division of Otolaryngology, Head and Neck Surgery (K.M.C. R.H.W., N.Q., R.K.G.), University of Utah, Salt Lake City, Utah
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Gluth MB. Rhabdomyosarcoma and Other Pediatric Temporal Bone Malignancies. Otolaryngol Clin North Am 2015; 48:375-90. [DOI: 10.1016/j.otc.2014.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Eksan MS, Noorizan Y, Chew YK, Noorafidah MD, Asma A. Rare embryonal rhabdomyosarcoma of external acoustic canal: a case report and literature review. Am J Otolaryngol 2014; 35:814-5. [PMID: 25128187 DOI: 10.1016/j.amjoto.2014.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/08/2014] [Accepted: 07/15/2014] [Indexed: 11/20/2022]
Abstract
Embryonal rhabdomyosarcoma of external ear canal is very rare, even in the pediatric population. We report an embryonal rhabdomyosarcoma of external acoustic canal, occurring in a 12-year-old Chinese girl who presented with left ear canal mass. Wide local excision of the mass was done under local anesthesia. Histopathological examination revealed the diagnosis. She then underwent 20 cycles of radiotherapy. CECT scan post treatment showed clearance of tumor cell. Now, patient is disease free for 5 years. We believe that early diagnosis followed by complete resection of the tumor with clear margin and radiotherapy improves the prognosis of the disease.
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Affiliation(s)
- M S Eksan
- ORL Department Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia.
| | - Y Noorizan
- ORL Department Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
| | - Y K Chew
- ORL Department Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
| | - M D Noorafidah
- Pathology Department Hospital Pakar Sultanah Fatimah, Muar, Johor, Malaysia
| | - A Asma
- ORL Head and Neck Surgery Department, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Muranjan M, Karande S, Parikh S, Sankhe S. A mistaken identity: rhabdomyosarcoma of the middle ear cleft misdiagnosed as chronic suppurative otitis media with temporal lobe abscess. BMJ Case Rep 2014; 2014:bcr-2014-206615. [PMID: 25240007 DOI: 10.1136/bcr-2014-206615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A 5-year-old girl presented with a 3-month history of left side facial palsy, followed sequentially by purulent ear discharge, complete external ophthalmoplaegia and blurred vision. On clinical examination she was febrile with left-sided conductive hearing loss. She was clinically diagnosed to have chronic suppurative otitis media of the unsafe type with petrous apicitis, middle cranial fossa abscess and cavernous sinus involvement. Preliminary CT scan findings were reported as a large left temporal lobe abscess and left otitis media with cholesteatoma. MRI of the brain obtained later corroborated the abnormalities detected on the CT scan. Ten days after admission, a mass was seen protruding from the external auditory canal. A biopsy of the mass was obtained and sent for histopathological examination. Meanwhile, review of the MRI suggested an aggressive neoplasm such as sarcoma/rhabdomyosarcoma. Histopathology clinched the final diagnosis of an anaplastic type of embryonal rhabdomyosarcoma of the middle ear cleft.
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Affiliation(s)
- Mamta Muranjan
- Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - Sunil Karande
- Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - Shefali Parikh
- Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - Shilpa Sankhe
- Department of Radiology, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
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19
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Zhang X, Ma K, Wang J, Wu W, Ma L, Huang D. A Prospective Evaluation of the Combined Helical Tomotherapy and Chemotherapy in Pediatric Patients with Unresectable Rhabdomyosarcoma of the Temporal Bone. Cell Biochem Biophys 2014; 70:103-8. [DOI: 10.1007/s12013-014-9864-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Radhakrishnan R, Son HJ, Koch BL. Petrous apex lesions in the pediatric population. Pediatr Radiol 2014; 44:325-39; quiz 323-4. [PMID: 24584333 DOI: 10.1007/s00247-013-2836-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/17/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
Abstract
A variety of abnormal imaging findings of the petrous apex are encountered in children. Many petrous apex lesions are identified incidentally while images of the brain or head and neck are being obtained for indications unrelated to the temporal bone. Differential considerations of petrous apex lesions in children include "leave me alone" lesions, infectious or inflammatory lesions, fibro-osseous lesions, neoplasms and neoplasm-like lesions, as well as a few rare miscellaneous conditions. Some lesions are similar to those encountered in adults, and some are unique to children. Langerhans cell histiocytosis (LCH) and primary and metastatic pediatric malignancies such as neuroblastoma, rhabomyosarcoma and Ewing sarcoma are more likely to be encountered in children. Lesions such as petrous apex cholesterol granuloma, cholesteatoma and chondrosarcoma are more common in adults and are rarely a diagnostic consideration in children. We present a comprehensive pictorial review of CT and MRI appearances of pediatric petrous apex lesions.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA,
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21
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Crozier E, Rihani J, Koral K, Cope-Yokoyama S, Rakheja D, Ulualp SO. Embryonal rhabdomyosarcoma of the auricle in a child. Pediatr Int 2012; 54:945-7. [PMID: 23279030 DOI: 10.1111/j.1442-200x.2012.03621.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe the diagnosis and management of a child with embryonal rhabdomyosarcoma of the auricle and emphasize both clinical and radiological findings of this rare condition. A nine-year-old boy presented for evaluation of a slowly enlarging left auricle mass. The mass was nodular, violaceous, semi-translucent, and hyperpigmented with an overlying pseudo-vesicular plaque. The mass appeared to involve the left cavum concha, root of the helix, superior aspect of the external auditory canal, the tragus and extend to a deep preauricular component. MR imaging documented a lobulated soft tissue mass surrounding the external auditory canal with superficial involvement of the pinna. Incisional biopsy of the mass suggested embryonal rhabdomyosarcoma. The tumor was completely removed by total auriculectomy and lateral temporal bone resection. The final diagnosis was embryonal rhabdomyosarcoma. Although rare, otolaryngologists, pediatricians, and radiologists need to consider rhabdomyosarcoma in the differential diagnosis of auricle mass in children.
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Affiliation(s)
- Emily Crozier
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9035, USA
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22
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Razek AA, Huang BY. Lesions of the petrous apex: classification and findings at CT and MR imaging. Radiographics 2012; 32:151-73. [PMID: 22236899 DOI: 10.1148/rg.321105758] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The petrous apex is a complex region of the central skull base that is surrounded by a number of important vascular and neural structures and can be home to a wide range of disease processes. Lesions arising in or spreading to the petrous apex cause varied and occasionally severe clinical sequelae, which typically result from mass effect or direct invasion of the cranial nerves, brainstem, or internal carotid artery. Because the petrous apex is not amenable to direct examination, cross-sectional imaging with computed tomography and magnetic resonance (MR) imaging plays an important role in diagnosis and characterization of lesions occurring there. Petrous apex lesions can be classified on the basis of their origin into the following categories: developmental lesions, inflammatory lesions, benign tumors, malignant tumors, vascular lesions, and osseous dysplasias. The most common lesions arising in the petrous apex are cholesterol granulomas, which can be reliably diagnosed with MR imaging due to their high signal intensity on both T1-weighted images and T2-weighted images. In addition, one should also be familiar with anatomic variants or pseudolesions in the petrous apex that can be mistaken for pathologic conditions.
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Affiliation(s)
- Ahmed Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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23
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Agarwal NM, Popat VC, Traviad C, Srivastava A. Clinical and histopathological study of mass in ear: a study of fifty cases. Indian J Otolaryngol Head Neck Surg 2012; 65:520-5. [PMID: 24427707 DOI: 10.1007/s12070-011-0434-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 12/20/2011] [Indexed: 12/28/2022] Open
Abstract
Study of mass in ear was undertaken with the aim that clinical diagnosis was in most but not all cases consistent with the histo-pathological diagnosis. Therefore incisional or excisional biopsy with histo-pathological study is a must in all types of small masses in ear. A study of 50 patients, attending Ear, Nose and Throat department, was done and specimen collected from them and subjected to histopathological examination. These masses were further classified as inflammatory, benign and malignant lesions and the frequency of their occurrence in saurashtra region (Jamnagar, GUJARAT), their age and sex distribution were observed. Most common lesion was found to be inflammatory Polyps (20), followed by Cholesteatomas (12) and chronic non-specific inflammations (7), Abscess (1). In malignant lesions Squamous cell carcinoma (7) was the commonest followed by Embryonal rhabdomyosarcoma (1) and in benign lesion, Carcinoid tumor (1) and Nevus (1) were diagnosed on histo-pathological examination. Right side masses were more common than left side; males were more affected than females. Adolescents/children more affected than adults for benign lesions while reverse was true for malignant lesions.
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Affiliation(s)
- Neeru M Agarwal
- Department of Pathology, M. P. Shah Medical College, C/15 Prof Quarters, Jamnagar, 361008 Gujarat India
| | - V C Popat
- Department of Pathology, M. P. Shah Medical College, B-5-A, Prof Quarters, Jamnagar, 361008 Gujarat India
| | - Chintan Traviad
- Resident in Pathology, M. P. Shah Medical College, Jamnagar, Gujarat India
| | - Atul Srivastava
- Resident in Pathology, M. P. Shah Medical College, Jamnagar, Gujarat India
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Abstract
Bone tumors are fortunately rare, but small cell tumors of bone are a relatively common subset of these lesions. They comprise of a diverse group of primary and metastatic neoplasms in both children and adults. The most common small cell tumors of bone include Ewing sarcoma/primitive neuroectodermal tumor, small cell osteosarcoma, multiple myeloma, lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma, and Langerhans cell histiocytosis. Although each entity has its distinctive features, the differential diagnosis of this group of tumors is still challenging because they are all "small, blue, and round cell tumors", histologically. The correct diagnosis of small cell tumors of bone depends on an evaluation of clinical, radiologic, pathologic, and genetic features. Patients' age and sex are very important, as are the signs and symptoms at presentation. Radiologically, which bone is involved, the specific portion of the bone (epiphysis, metaphysis, or diaphysis; cortex vs. medulla) involved, and the radiographic manifestations (lytic, blastic, or mixed lytic and blastic) are also often critical parameters for the diagnosis. In recent years, with a better understanding of the molecular and cytogenetic background of several small cell tumors, more accurate diagnoses have been supported by the clinicopathologic criteria and by a panel of immunohistochemical studies. In this review we will provide an overview of the clinical, radiologic, pathologic, and genetic characteristics of these tumors.
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Histopathological temporal bone study of the metastatic rhabdomyosarcoma. Auris Nasus Larynx 2009; 36:221-3. [DOI: 10.1016/j.anl.2008.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 04/21/2008] [Accepted: 05/11/2008] [Indexed: 11/22/2022]
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Zhong J, Li ST, Yao XH, Jin B, Wan L. An intrasellar rhabdomyosarcoma misdiagnosed as pituitary adenoma. ACTA ACUST UNITED AC 2008; 68 Suppl 2:S29-33; discussion S33. [PMID: 18037040 DOI: 10.1016/j.surneu.2007.01.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 01/30/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rhabdomyosarcoma is a malignant tumor of the skeletal muscle cells. Those tumors mainly affect children and arise in primitive fetal mesenchyme even at sites that do not contain skeletal muscle. However, very few intracranial rhabdomyosarcomas have been reported. No previous case of primary intrasellar rhabdomyosarcoma except for 1 case has been reported in the literature. CASE DESCRIPTION A 44-year-old woman presented with fatigue and diplopia associated with amenorrhea and galactorrhea. Visual field evaluation revealed a superior temporal deficit in both eyes. A right afferent pupillary defect was present. Magnetic resonance imaging revealed an intrasellar tumor with suprasellar extension. The tumor involved the sella turcica and right cavernous sinus. The patient was preoperatively diagnosed as pituitary adenoma, which was confirmed pathologically as rhabdomyosarcoma after the operation. CONCLUSIONS Our findings suggest that rhabdomyosarcoma should be considered in the differential diagnosis of a primary intrasellar neoplasm.
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Affiliation(s)
- Jun Zhong
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200092, People's Republic of China.
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Sbeity S, Abella A, Arcand P, Quintal MC, Saliba I. Temporal bone rhabdomyosarcoma in children. Int J Pediatr Otorhinolaryngol 2007; 71:807-14. [PMID: 17346806 DOI: 10.1016/j.ijporl.2007.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 02/01/2007] [Accepted: 02/01/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Rhabdomyosarcoma is the most frequent soft tissue sarcoma in the pediatric age group. The authors present their series of rhabdomyosarcoma of the temporal bone in children at Saint Justine Hospital. The twofold objective of this study is to illustrate the clinical presentation, management, and prognosis of this malignant striated muscle tumor, and to compare these results with previously reported series. METHODS A retrospective study was conducted of patients diagnosed and treated for rhabdomyosarcoma of the head and neck at Saint Justine Hospital, a tertiary pediatric center, between 1970 and 2005. Only cases of temporal bone rhabdomyosarcoma were included in the study. A thorough review of medical and surgical charts was performed to obtain demographic, clinical, paraclinical, and therapeutic data, which were subsequently analyzed and compared to published results. A MEDLINE search yielded 34 studies dealing with temporal bone rhabdomyosarcoma since the year 1966. RESULTS Thirty-nine patients with rhabdomyosarcoma of the head and neck region were identified, among which only six children had temporal bone rhabdomyosarcoma. The mean age at the time of diagnosis was 4.15 years. Chronic otitis media was the most common clinical presentation. Five children had the embryonal subtype and one had the botryoid subtype on histology. All patients except two received combined chemotherapy and radiotherapy as treatment. Five-year survival rate was 66%. Our results match those reported in the literature 41-81%. CONCLUSION Rhabdomyosarcoma of the temporal bone is an aggressive tumor that clinically simulates chronic otitis media. A high index of suspicion should be raised in the context of otitis media that is unresponsive to ordinary medical treatment. A biopsy is hence recommended in the presence of polyps in the external auditory canal that are resistant to medical treatment. Early diagnosis and the adoption of multimodal therapy offer the best outcome.
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Affiliation(s)
- S Sbeity
- ENT, Hôpital Sainte-Justine, 3175, Côte Sainte-Catherine, Service ORL, Montréal, Que. H3T 1C5, Canada.
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Abstract
Facial palsy is not an uncommon presentation to an emergency department. Whereas most patients will ultimately receive a diagnosis of Bell palsy (idiopathic peripheral seventh cranial nerve palsy), a subset will have an identifiable cause for their facial paralysis. Children are more likely to have an identifiable cause than are adults. We present a case in which a child presented with acute peripheral facial nerve palsy and was found to have temporal bone rhabdomyosarcoma. The key clinical finding was the presence of both 7th and 12th cranial nerve palsy.
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Affiliation(s)
- Samuel R Reid
- Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, St. Paul, MN 55102, USA.
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29
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Devaney KO, Boschman CR, Willard SC, Ferlito A, Rinaldo A. Tumours of the external ear and temporal bone. Lancet Oncol 2005; 6:411-20. [PMID: 15925819 DOI: 10.1016/s1470-2045(05)70208-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Symptoms such as hearing impairment, tinnitus, or a disturbance in sense of balance can generally be attributed to non-neoplastic causes, such as otitis media, otosclerosis, or trauma. Less commonly, auricular signs and symptoms are the result of non-neoplastic and neoplastic space-occupying lesions. The external ear can be the site of development of squamous carcinomas and basal-cell carcinomas; the middle ear and inner ear can host metastatic deposits, and primary squamous carcinomas and adenocarcinomas. Most auricular malignant diseases occur in adulthood; only the rhabdomyosarcomas of the middle ear arise in children. Most malignant diseases of the auricular apparatus are treated by a combination of surgery (commonly including radical excision of temporal bone), radiotherapy, and chemotherapy.
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