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Segna E, Civita F, Denaro N, Beltramini GA. Cavernous sinus metastasis in head and neck cancer: Focus on oral squamous cell cancer. Oral Oncol 2024; 152:106784. [PMID: 38593719 DOI: 10.1016/j.oraloncology.2024.106784] [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: 02/05/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
Intracranial metastatic disease is rarely found in head and neck cancer (HNC), in particular, cavernous sinus (CS) involvement is difficult to recognize, because of its rarity, not specific symptoms associated and challenging imaging features. We report our experience in 4 cases, reviewing also the English literature. We analysed data from 21 patients showing that CS metastasis is a dramatic event, with rapid onset, usually starting with neurological manifestations (ophthalmoplegia, headache and trigeminal dysesthesia) and almost unavoidable outcome (DOD in 18/21 patients). Furthermore, we assessed that the diagnostic confirmation could be difficult to perform because of the need for multiple exams and time consuming procedures. Unfortunately, usual antineoplastic therapies seem to be not effective in prolonging survival, also because patients are already weakened by primary tumour treatments. The only option that seems useful in improving outcomes is immunotherapy.
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Affiliation(s)
- E Segna
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy.
| | - F Civita
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Italy
| | - N Denaro
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - G A Beltramini
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Italy
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2
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Jadhav A, Gupta A, Bhola N, Karia H. Remote Metastasis of Oral Squamous Cell Carcinoma to Cavernous Sinus: A Report of a Rare Case. Cureus 2022; 14:e27373. [PMID: 36046276 PMCID: PMC9418633 DOI: 10.7759/cureus.27373] [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: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022] Open
Abstract
The most frequently occurring malignant tumor of epithelial origin of the head and neck region is squamous cell carcinoma (SCC). It is characterized by loco regional dissemination whilst remote metastasis (RM) is rare. The lung, bone, and liver are the frequent sites for RM whilst involvement of the brain or cavernous sinus has an exceptionally rare occurrence. Owing to its rarity, lack of awareness amongst head neck surgeons, and absence of any evidence-based protocol, the optimal management strategies in this population are controversial and, hence, associated with dismal outcomes. The present case report exhibits a rare presentation of cavernous sinus metastasis in human papillomavirus (HPV)-related primary SCC arising from the lower gingivobuccal complex.
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3
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Escaping from the hunt. Surv Ophthalmol 2020; 66:1065-1069. [PMID: 33129799 DOI: 10.1016/j.survophthal.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022]
Abstract
A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V1,2,3, and VI). She was initially diagnosed with Tolosa-Hunt syndrome and had a partial response to systemic corticosteroids. Skull base biopsy eventually showed poorly differentiated carcinoma consistent with perineural spread of squamous cell carcinoma.
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4
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Carpenter K, Decater T, Iwanaga J, Maulucci CM, Bui CJ, Dumont AS, Tubbs RS. Revisiting the Vertebral Venous Plexus-A Comprehensive Review of the Literature. World Neurosurg 2020; 145:381-395. [PMID: 33049379 DOI: 10.1016/j.wneu.2020.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022]
Abstract
The venous drainage of the vertebral and paravertebral regions is important for a better understanding of hematogenous disease spread. Moreover, the spine surgeon must be well acquainted with this anatomy to minimize intraoperative and postoperative complications. A comprehensive review of the vertebral venous plexus (Batson plexus) was performed with a concentration on the clinical and surgical correlations of this venous network.
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Affiliation(s)
- Kennedy Carpenter
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Tess Decater
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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5
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Intradural Metastasis from Cutaneous Squamous Cell Carcinoma Causing Cauda Equina Syndrome. Can J Neurol Sci 2019. [DOI: 10.1017/cjn.2019.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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6
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Cameron MC, Lee E, Hibler BP, Giordano CN, Barker CA, Mori S, Cordova M, Nehal KS, Rossi AM. Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol 2019; 80:321-339. [PMID: 29782901 DOI: 10.1016/j.jaad.2018.02.083] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/21/2022]
Abstract
As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education series provides a comprehensive and contemporary review of basal cell carcinoma. The second article in this series will present both the current standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.
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Affiliation(s)
- Michael C Cameron
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian P Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cerrene N Giordano
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shoko Mori
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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7
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van Vugt VA, Saria MG, Javier A, Kesari N, Turpin T, Kesari S. Neurological improvement of perineural and leptomeningeal spread of squamous cell carcinoma treated with intrathecal chemotherapy and systemic EGFR inhibition. CNS Oncol 2017; 6:269-274. [PMID: 28984139 DOI: 10.2217/cns-2017-0010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Squamous cell carcinoma (SCC) is a common cancer of the skin. Risk factors include fair skin, excessive sun and ultraviolet light exposure, and history of xeroderma pigmentosa. Perineural invasion (PNI), an uncommon manifestation of SCC, involves microscopic tumor cells invading various layers of the nerve sheath. It is associated with a poorer prognosis. Standard treatment for PNI includes radiation therapy. Here, we describe a case an older gentleman with a history of SCC with PNI successfully treated with erlotinib and intrathecal chemotherapy.
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Affiliation(s)
- Vincent Alexander van Vugt
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, The Netherlands
| | - Marlon Garzo Saria
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, The Netherlands
| | - Andres Javier
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, The Netherlands
| | - Navin Kesari
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, The Netherlands
| | - Tiffany Turpin
- Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute & Pacific Neuroscience Institute at Providence Saint John's Health Center, Santa Monica, CA 90404, USA.,Department of Neurosciences, Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Santosh Kesari
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, The Netherlands
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8
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Dolci RLL, Ditzel Filho LFS, Goulart CR, Upadhyay S, Buohliqah L, Lazarini PR, Prevedello DM, Carrau RL. Anatomical nuances of the internal carotid artery in relation to the quadrangular space. J Neurosurg 2017; 128:174-181. [PMID: 28298027 DOI: 10.3171/2016.10.jns16381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the anatomical variations of the internal carotid artery (ICA) in relation to the quadrangular space (QS) and to propose a classification system based on the results. METHODS A total of 44 human cadaveric specimens were dissected endonasally under direct endoscopic visualization. During the dissection, the anatomical variations of the ICA and their relationship with the QS were noted. RESULTS The space between the paraclival ICAs (i.e., intercarotid space) can be classified as 1 of 3 different shapes (i.e., trapezoid, square, or hourglass) based on the trajectory of the ICAs. The ICA trajectories also directly influence the volumetric area of the QS. Based on its geometry, the QS was classified as one of the following: 1) Type A has the smallest QS area and is associated with a trapezoid intercarotid space, 2) Type B corresponds to the expected QS area (not minimized or enlarged) and is associated with a square intercarotid space, and 3) Type C has the largest QS area and is associated with an hourglass intercarotid space. CONCLUSIONS The different trajectories of the ICAs can modify the area of the QS and may be an essential parameter to consider for preoperative planning and defining the most appropriate corridor to reach Meckel's cave. In addition, ICA trajectories should be considered prior to surgery to avoid injuring the vessels.
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Affiliation(s)
- Ricardo L L Dolci
- Departments of1Otolaryngology-Head & Neck Surgery and.,3Department of Otolaryngology-Head & Neck Surgery, Santa Casa de Misericórida de São Paulo,Brazil
| | - Leo F S Ditzel Filho
- 2Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio; and
| | - Carlos R Goulart
- 2Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio; and
| | | | | | - Paulo R Lazarini
- 3Department of Otolaryngology-Head & Neck Surgery, Santa Casa de Misericórida de São Paulo,Brazil
| | - Daniel M Prevedello
- Departments of1Otolaryngology-Head & Neck Surgery and.,2Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio; and
| | - Ricardo L Carrau
- Departments of1Otolaryngology-Head & Neck Surgery and.,2Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio; and
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9
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Wu CY, Huang HM, Cho DY. An acute bleeding metastatic spinal tumor from HCC causes an acute onset of cauda equina syndrome. Biomedicine (Taipei) 2015; 5:18. [PMID: 26298047 PMCID: PMC4547328 DOI: 10.7603/s40681-015-0018-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/26/2015] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is an aggressive tumor that frequently occurs in the setting of chronic liver disease and cirrhosis. Herein, we describe a case where a patient presented with acute onset cauda equina syndrome due to an intradural and extramedullary metastatic tumor bleeding from hepatocellular carcinoma (HCC). The patient had lower back pain that had radiated to the bilateral lower legs for 3 weeks. Then, the patient had experienced an acute onset of bilateral lower leg weakness as well as bladder-urinary dysfunction 2 days before going to the ER. The patient received a laminectomy from the L1 to L4 vertebra, removing the intradural spinal tumor and hematoma. To the best of our knowledge, this is the first reported case of HCC metastasized to the cauda equina with tumor bleeding causing cauda equina syndrome.
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Affiliation(s)
- Chih-Ying Wu
- Department of Neurosurgery, China Medical University Hospital, 404, Taichung, Taiwan
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10
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Koukkoulli A, Koutroumanos N, Kidd D. Perineural Spread of Cutaneous Squamous Cell Carcinoma Manifesting as Ophthalmoplegia. Neuroophthalmology 2015; 39:144-146. [PMID: 27928347 PMCID: PMC5123107 DOI: 10.3109/01658107.2015.1035449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/13/2022] Open
Abstract
An 89-year-old female presented with horizontal diplopia and was diagnosed with VI nerve palsy attributed to a microvascular event. She subsequently progressed to develop an orbital apex syndrome, with neuroimaging demonstrating tumour invasion. Eighteen months earlier, she had squamous cell carcinoma of the forehead excised with clear margins. Intraneural and perineural spread of squamous carcinoma from the face to the cranial cavity is an important cause of delayed cranial nerve palsies after local excision of the skin tumour.
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Affiliation(s)
- Antigoni Koukkoulli
- Department of Neuro-Ophthalmology, Royal Free HospitalLondonUK and
- Moorfields Eye Hospital NHS TrustLondonUK
| | - Nikolas Koutroumanos
- Department of Neuro-Ophthalmology, Royal Free HospitalLondonUK and
- Moorfields Eye Hospital NHS TrustLondonUK
| | - Desmond Kidd
- Department of Neuro-Ophthalmology, Royal Free HospitalLondonUK and
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11
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Capek S, Amrami KK, Howe BM, Spinner RJ. Perineural tumor spread to the muscle: An alternative for muscle metastasis? Clin Anat 2014; 28:560-2. [DOI: 10.1002/ca.22485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Stepan Capek
- Department of NeurosurgeryMayo ClinicRochester Minnesota
- International Clinical Research Center, St. Anne's University Hospital BrnoBrno Czech Republic
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12
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Wirth LJ, Plotkin SR, Emerick KS, Cunnane ME, Faquin WC. Case records of the Massachusetts General Hospital. Case 29-2012. A 49-year-old man with pain and cranial-nerve palsies after treatment of oral cancer. N Engl J Med 2012; 367:1136-47. [PMID: 22992078 DOI: 10.1056/nejmcpc1104565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lori J Wirth
- Department of Medical Oncology, Massachusetts General Hospital, Boston, USA
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13
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Gasco J, Kew Y, Livingston A, Rose J, Zhang YJ. Dissemination of prostate adenocarcinoma to the skull base mimicking giant trigeminal schwannoma: anatomic relevance of the extradural neural axis component. Skull Base 2011; 19:425-30. [PMID: 20436844 DOI: 10.1055/s-0029-1224774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report an unusual case of a large metastatic lesion from prostate adenocarcinoma with its epicenter located in Meckel's cave. The patient presented with acute neurological deterioration due to pontomesencephalic, cranial nerve, and temporal lobe compression. This lesion radiologically mimicked a giant trigeminal schwannoma. Complete surgical resection was achieved with improvement in the performance status of the patient. The anatomic relevance the extradural neural axis component in the process of dissemination of prostate adenocarcinoma to the skull base is highlighted.
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Affiliation(s)
- Jaime Gasco
- Methodist Neurological Institute, Houston, Texas
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14
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Devkota B, Patel H. Meningeal carcinomatosis from cervical cancer: a case report and review of the literature. Hosp Pract (1995) 2010; 38:117-21. [PMID: 20890060 DOI: 10.3810/hp.2010.06.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Meningeal carcinomatosis (MC) from cervical cancer is rare. Diagnosis of this disease is often delayed due to variable presentation. We report an interesting case of MC from the uterine cervix and review general diagnostic and treatment considerations. The patient received chemotherapy and radiotherapy for stage IIB cervical cancer with resolution of symptoms for 3 years. Metastatic lesions were found in the right lung and paraaotic nodes on follow-up positron emission tomography scan, which completely resolved with subsequent chemotherapy. Unfortunately, the patient developed neurological symptoms consistent with MC, which was confirmed by cerebrospinal fluid cytology. Because of her poor cognition, available options were discussed with her family. She died peacefully in palliative care.
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Abstract
A 70-year-old man presented complaining of lid and facial drooping and facial numbness, which progressed over several months. Magnetic resonance imaging of the head showed an enlarged right cavernous sinus. His past medical history was remarkable to squamous cell carcinoma of the face. The patient underwent a craniotomy with biopsy of the cavernous sinus that confirmed malignancy. High index of suspicion in a patient that presents facial drooping and/or numbness should alert ophthalmologists about the occurrence of perineural spread of a previous malignant lesion of the skin.
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Bai ZQ, Cai EY, Wang SQ, Li ZJ, Wang SB. Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel's cave: a preliminary anatomic study of an endoscopy-based operative approach. Neurosci Bull 2009; 25:376-82. [PMID: 19927174 PMCID: PMC5552503 DOI: 10.1007/s12264-009-0605-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To provide a new approach for the treatment of tumor in Meckel's cave, by dissecting adjacent structures of the nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel's cave approach. METHODS Fifteen adult cadaver heads (30 sides) were dissected and the correlated anatomic landmarks were observed, measured and analyzed in an operative route. RESULTS The approach was divided into 3 steps: entering the maxillary sinus, the later pterygopalatine fossa and the final Meckel's cave. Safe access to Meckel's cave could be achieved by tracing the vidian neurovascular bundles and dissecting the quadrangular space (QS). The distances from the nasal columella to the apertura maxillaries, the sphenopalatine foramen, and the anterior foramen of the pterygoid canal were (44.08+/-2.61) mm, (64.83+/-2.42) mm, and (70.43+/-2.94) mm, respectively. The angles between the horizontal plate of the palatine bone and the link from nasal columella to apertura maxillaries, between the horizontal plate of the palatine bone and the link from nasal columella to sphenopalatine foramen were (38.10+/-2.46) degrees and (26.15+/-2.26) degrees , respectively. CONCLUSION The endoscopic approach of transnasal maxillary sinus-pterygopalatine fossa-Meckel's cave (ENMPA) is a safe and direct way to access Meckel's cave, and could be employed for the treatment of tumor in Meckel's cave.
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Affiliation(s)
- Zhi-Qiang Bai
- Department of Neurosurgery, Affiliated Hospital of Qingdao University Medical College, Qingdao, 266003 China
| | - En-Yuan Cai
- Department of Neurosurgery, Affiliated Hospital of Qingdao University Medical College, Qingdao, 266003 China
| | - Shi-Qiang Wang
- Department of Neurosurgery, Affiliated Hospital of Qingdao University Medical College, Qingdao, 266003 China
| | - Zhao-Jian Li
- Department of Neurosurgery, Affiliated Hospital of Qingdao University Medical College, Qingdao, 266003 China
| | - Shou-Biao Wang
- Department of Anatomical Sciences, Qingdao University Medical College, Qingdao, 266071 China
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17
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Sung A, Bergsneider M, Wang MB. Transnasal endoscopic surgery of the cavernous sinus for tissue diagnosis. Laryngoscope 2009; 120:282-4. [DOI: 10.1002/lary.20707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Squamous cell carcinomatous meningitis. Oncol Rev 2009. [DOI: 10.1007/s12156-009-0018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Gardner P, Osawa S, Seker A, Rhoton AL. The front door to meckel's cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 2009; 64:ons71-82; discussion ons82-3. [PMID: 19240575 DOI: 10.1227/01.neu.0000335162.36862.54] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Tumors within Meckel's cave are challenging and often require complex approaches. In this report, an expanded endoscopic endonasal approach is reported as a substitute for or complement to other surgical options for the treatment of various tumors within this region. METHODS A database of more than 900 patients who underwent the expanded endoscopic endonasal approach at the University of Pittsburgh Medical Center from 1998 to March of 2008 were reviewed. From these, only patients who had an endoscopic endonasal approach to Meckel's cave were considered. The technique uses the maxillary sinus and the pterygopalatine fossa as part of the working corridor. Infraorbital/V2 and the vidian neurovascular bundles are used as surgical landmarks. The quadrangular space is opened, which is bound by the internal carotid artery medially and inferiorly, V2 laterally, and the abducens nerve superiorly. This offers direct access to the anteroinferomedial segment of Meckel's cave, which can be extended through the petrous bone to reach the cerebellopontine angle. RESULTS Forty patients underwent an endoscopic endonasal approach to Meckel's cave. The most frequent abnormalities encountered were adenoid cystic carcinoma, meningioma, and schwannomas. Meckel's cave and surrounding structures were accessed adequately in all patients. Five patients developed a new facial numbness in at least 1 segment of the trigeminal nerve, but the deficit was permanent in only 2. Two patients had a transient VIth cranial nerve palsy. Nine patients (30%) showed improvement of preoperative deficits on Cranial Nerves III to VI. CONCLUSION In selected patients, the expanded endoscopic endonasal approach to the quadrangular space provides adequate exposure of Meckel's cave and its vicinity, with low morbidity.
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Affiliation(s)
- Amin B Kassam
- Department of Neurosurgery and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Treatment strategies of space-occupying intradural metastases of the cauda equina of nonneurogenic origin. Acta Neurochir (Wien) 2009; 151:207-15. [PMID: 19247571 DOI: 10.1007/s00701-009-0214-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Accepted: 02/07/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Compressive intradural metastases of the cauda equina are a rare site of metastatic spread in systemic cancer. So far, only few reports have been published with conflicting statements concerning a surgical versus nonsurgical approach. METHOD Five patients with symptomatic space-occupying intradural metastases of the cauda equina were analyzed retrospectively, focusing on the influence of surgical intervention on pain relief, neurological outcome and thus the patients' quality of life. FINDINGS At the time of diagnosis, all patients were in an advanced metastatic state. Surgical resection was the primary treatment in four patients and radiotherapy in one. Despite infiltration of the cauda rootlets, gross total tumour resection could be achieved in two of the four patients treated surgically. Functional outcome was beneficial in these patients with marked and immediate relief of pain and improvement of motor function even following incomplete tumour resection. CONCLUSIONS Surgical treatment of compressive intradural metastases of the cauda equina seems to be feasible with low operative risk and with the potential benefit of an immediate relief of pain and improvement in motor function and thus an increase in quality of life.
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Dunn M, Morgan MB, Beer TW. Perineural invasion: identification, significance, and a standardized definition. Dermatol Surg 2009; 35:214-21. [PMID: 19215258 DOI: 10.1111/j.1524-4725.2008.34412.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mohs surgeons have expanded the range of cancers treated using the Mohs technique. Mohs surgeons today are expected to diagnose perineural invasion (PNI) when as little as one nerve is involved. OBJECTIVE To address the issue of identification and significance of perineural invasion from the perspective of the Mohs surgeon. The experience of other medical specialties dealing with the same issue are reviewed and applied. METHODS AND MATERIALS This article is based on a review of the entire medical literature regarding PNI. RESULTS PNI is a significant complication of cancers, regardless of the organ of origin. The most common complication of PNI is recurrence of the cancer. Leptomeningeal carcinomatosis occurs in neglected or aggressive cancers. The process is indolent and contiguous, lending itself well to treatment with Mohs surgery. There are diagnostic mimics of PNI. Variation of reported incidences and cure rates suggest that diagnostic criteria for PNI may not be consistent from study to study. CONCLUSION We propose the following definition for the minimum histopathologic criteria required to make a diagnosis of PNI: "In the presence of a malignancy, PNI may be diagnosed according to the observation of cytologically malignant cells in the perineural space of nerves. In equivocal cases, the observation of total or near-total circumferential involvement is supportive, as is the presence of perineural tracking in tangential sections and intraneural involvement."
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Affiliation(s)
- Martin Dunn
- Skin Cancer Specialist Inc., Sarasota, Florida, USA.
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Uchida K, Kobayashi S, Yayama T, Muramatsu J, Kurokawa T, Imamura Y, Baba H. Metastatic involvement of sacral nerve roots from uterine carcinoma: a case report. Spine J 2008; 8:849-52. [PMID: 17981096 DOI: 10.1016/j.spinee.2007.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 06/14/2007] [Accepted: 06/18/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Metastatic involvement of peripheral nerves is considered common in carcinoma of the head and neck with perineural invasion. It is also possible that perineural and endoneural invasion occur in presacral local recurrence. Little is reported about metastasis in pelvic lesions including sacral nerve roots. PURPOSE We describe the clinical presentation and diagnosis of metastatic involvement of sacral nerve roots retrogradely from uterine carcinoma, and its implication for spine surgeons, along with a brief review of literature. STUDY DESIGN/SETTING A case report of a patient with metastatic lesions in S1 and S2 nerve roots originating from uterine adenocarcinoma is presented. METHODS A 39-year-old woman with history of uterine cancer presented with persistent severe low back pain, intractable radicular pain, and neurological deficit in the right lower extremity. She had undergone radical hysterectomy for uterine adenocarcinoma 4 years ago followed by chemotherapy and radiotherapy. Magnetic resonance imaging (MRI) revealed abnormal swelling of the S1 and S2 nerve roots along with a soft-tissue mass in the retroperitoneal space. RESULTS The patient underwent surgical rhizotomy and histology of the roots revealed metastatic tumor in the dorsal root ganglion. The patient had good pain relief, she died of metastatic disease 3 years later. CONCLUSIONS Despite being uncommon, sacral nerve root metastasis should be considered in some patients with history of cancer of pelvic organs including the uterus. MR images were of little value in differentiating a carcinomatous lesion from a benign lesion.
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Affiliation(s)
- Kenzo Uchida
- Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Shimoaizuki 23, Matsuoka, Fukui 910-1193, Japan.
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Ignatius RT, Wills SM, Nadeau L, Deperalta-Venturina M, Weiner S. Leptomeningeal carcinomatosis due to squamous cell carcinoma of the uterine cervix associated with HPV-45. J Clin Oncol 2008; 26:154-6. [PMID: 18165650 DOI: 10.1200/jco.2007.14.3180] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Renjitha T Ignatius
- Department of Internal Medicine, Division of Hematology/Oncology, William Beaumont Hospital, Royal Oak, MI, USA
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Gharabaghi A, Heckl S, Kaminsky J, Torka W, Nägele T, Tatagiba M, Löwenheim H. Hirnnervenausfälle durch ungewöhnliche Schädelbasisläsionen des Sinus cavernosus. HNO 2007; 55:278-80. [PMID: 17410393 DOI: 10.1007/s00106-006-1459-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Gharabaghi
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
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Sullivan LM, Smee R. Leptomeningeal carcinomatosis from perineural invasion of a lip squamous cell carcinoma. ACTA ACUST UNITED AC 2006; 50:262-6. [PMID: 16732828 DOI: 10.1111/j.1440-1673.2006.01577.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Perineural invasion resulting in leptomeningeal carcinomatosis is a rare, but well-recognized phenomenon in head and neck carcinomas. We report the rare case of a patient with a squamous cell carcinoma of the lip resulting in leptomeningeal carcinomatosis and review the relevant published work. A 51-year-old man presented with progressive facial paraesthesia after treatment for a recurrent squamous cell carcinoma of the lower lip. Cavernous sinus involvement was confirmed on MRI and he received stereotactic radiotherapy. He subsequently developed progressive lower limb neurological signs. An MRI showed multiple enhancing leptomeningeal nodules in the cervical and lumbar spine consistent with leptomeningeal carcinomatosis. Whole spine radiotherapy and dexamethasone resulted in short-term stabilization of symptoms only and he rapidly succumbed to progressive neurological disease. To our knowledge, this is the first published report of a squamous cell carcinoma of the lip resulting in leptomeningeal disease of the cauda equina. It illustrates the potential aggressive natural history of squamous cell carcinomas with perineural invasion.
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Affiliation(s)
- L M Sullivan
- Department Radiation Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
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Maeda M, Maier SE, Sakuma H, Ishida M, Takeda K. Apparent diffusion coefficient in malignant lymphoma and carcinoma involving cavernous sinus evaluated by line scan diffusion-weighted imaging. J Magn Reson Imaging 2006; 24:543-8. [PMID: 16888792 DOI: 10.1002/jmri.20680] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the apparent diffusion coefficient (ADC) of malignant lymphomas and carcinomas involving cavernous sinus by line scan diffusion-weighted imaging (LSDWI) and to determine the usefulness of this method for differentiating between the two tumors. MATERIALS AND METHODS Four patients with malignant lymphomas and six patients with carcinomas were prospectively studied. LSDWI images were obtained with two different b values of 5 seconds/mm(2) and 1000 seconds/mm(2) in the coronal plane. The ADC values of the two types of tumors were calculated and compared. RESULTS LSDWI provided diagnostic images with minimum susceptibility artifacts and enabled measurement of the ADC. The ADC value (mean +/- SD) was 0.51 +/- 0.06 x 10(-3) mm(2)/second in malignant lymphomas and 0.99 +/- 0.08 x 10(-3) mm(2)/second in carcinomas. A significant difference in ADC values was found between the two (P < 0.01). CONCLUSION Malignant lymphomas showed significantly lower ADC value than carcinomas. ADC provides additional useful information about differentiation between these tumors.
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Affiliation(s)
- Masayuki Maeda
- Department of Radiology, Mie University School of Medicine, Tsu, Japan.
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Abstract
Leptomeningeal metastases (LM) are increasingly recognized as a devastating complication of solid tumors. Improved treatment of primary malignancy and advances in diagnostic imaging have led to an apparent increase in the number of patients diagnosed with LM. Unfortunately, therapeutic options remain limited. Radiotherapy is used to treat bulky tumor and provide symptomatic relief. Intrathecal chemotherapy benefits a selected subset of patients. The challenge to the future is to delineate the molecular mechanisms underlying LM and to develop novel therapeutic or prophylactic modalities to combat LM.
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