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Boosfeld L, Lang S, Mattheis S, Peis M, Zaun G, Waßenberg S, Baba HA, Hussain T, Kürten C. [Diagnosis, treatment and oncological outcome of cervical CUP-syndrome depending on p16 status]. Laryngorhinootologie 2024. [PMID: 39638322 DOI: 10.1055/a-2468-6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
The incidence of cervical squamous cell carcinoma (SCC)-CUP is increasing, with a significant proportion being HPV-associated. In this 10-year retrospective study, we analyzed clinical and therapeutic parameters of patients with cervical SCC-CUP. Primary tumor detection rates in patients with initial SCC-CUP (SCC-CUPinit) were assessed and mean overall survival and disease-free survival of patients without primary tumor detection after an extended diagnostic workup, i.e. definitive SCC-CUP (SCC-CUPdef), were analyzed taking p16-status into account to derive therapeutic recommendations.85% (n=131/155) of patients with CUPinit, presented with SCC followed by adenocarcinoma metastases in 7% (n=10/155). In 41% (n=54/131) of patients with SCC-CUPinit, a primary tumor was identified after an extended diagnostic workup; the primary tumor detection rate was significantly higher in p16-positive compared to p16-negative cases (63% vs. 23%, p<0,001). PET imaging specificity was 73% for both sensitivity and specificity. SCC-CUPdef were primarily treated surgically with adjuvant radio(chemo)therapy. SCC-CUPdef patients with positive vs. negative p16-status had significantly longer overall survival (53 vs. 41 Monate, p=0,037), as well as patients with cN1- vs. cN3-status and M0- vs. M1-status.p16-status influences diagnosis and therapy response in patients with SCC-CUP: in p16-positive SCC-CUPinit, primary tumor detection rates were significantly higher than in p16-negative SCC-CUPinit. In patients with SCC-CUPdef, p16-positivity was associated with improved overall survival, albeit to an extent which does not justify therapy de-escalation.
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Affiliation(s)
- Lukas Boosfeld
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - Stephan Lang
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - Stefan Mattheis
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - Micheal Peis
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - Gregor Zaun
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | | | - Timon Hussain
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Cornelius Kürten
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
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Harada Y, Toji M. Cancer Diaspora of Undifferentiated Cancer. Cureus 2024; 16:e52798. [PMID: 38389606 PMCID: PMC10883260 DOI: 10.7759/cureus.52798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Undifferentiated cancer is a rapidly progressing cancer with poor prognosis. Sometimes, it is diagnosed at an advanced stage, and its origin is difficult to detect. A very unusual cancer was revealed by autopsy. The patient was an 83-year-old survivor of colon cancer, melanoma, and laryngeal cancer. He had been under watchful course observation after survival from laryngeal cancer but suddenly died due to aspiration pneumonia. The autopsy revealed undifferentiated cancer infiltrated the entire body, which was misdiagnosed with positron emission tomography (PET)/CT scan and MRI. The origin of this cancer was a mystery even with vigorous pathological evaluation. The patient was told that his previous cancers were all healed; however, undifferentiated cancer progressed rapidly to the entire body, just like "cancer diaspora". This report highlights the limit of diagnostic imaging tools for aggressive cancer, sounding the alarm for clinicians to look beyond old presumptions.
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Affiliation(s)
- Yuko Harada
- Cardiology, Kawasaki Municipal Ida Hospital, Kawasaki, JPN
| | - Masao Toji
- Otolaryngology, Shin-Yurigaoka General Hospital, Kawasaki, JPN
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Abdel Razek AAK, Elsebaie NA, Gamaleldin OA, AbdelKhalek A, Mukherji SK. Role of MR Imaging in Head and Neck Squamous Cell Carcinoma. Magn Reson Imaging Clin N Am 2021; 30:1-18. [PMID: 34802573 DOI: 10.1016/j.mric.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Routine and advanced MR imaging sequences are used for locoregional spread, nodal, and distant staging of head and neck squamous cell carcinoma, aids treatment planning, predicts treatment response, differentiates recurrence for postradiation changes, and monitors patients after chemoradiotherapy.
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Affiliation(s)
| | - Nermeen A Elsebaie
- Department of Radiology, Alexandria Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria 21131, Egypt
| | - Omneya A Gamaleldin
- Department of Radiology, Alexandria Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria 21131, Egypt
| | - Amro AbdelKhalek
- Internship at Mansoura University Hospital, Mansoura Faculty of Medicine, 60 Elgomheryia Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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Kang T, Kim DW, Lee YJ, Cho YJ, Jung SJ, Park HK, Ha TK, Kim DH, Park JS, Moon SH, Ahn KJ, Baek HJ. Magnetic Resonance Imaging Features of Normal Thyroid Parenchyma and Incidental Diffuse Thyroid Disease: A Single-Center Study. Front Endocrinol (Lausanne) 2018; 9:746. [PMID: 30574121 PMCID: PMC6291476 DOI: 10.3389/fendo.2018.00746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background: No previous studies have investigated the feasibility of magnetic resonance imaging (MRI) diagnosis for detecting incidental diffuse thyroid disease (DTD). This study investigated MRI features of normal thyroid parenchyma and incidental DTD. Methods: From January 2008 to December 2017, 387 patients underwent neck MRI in our hospital due to tumor/nodal staging (n = 137), lymphadenopathy (n = 122), inflammatory neck lesion (n = 85), congenital neck lesion (n = 12), and patient request (n = 31). Among them, 375 patients were excluded because of a lack of appropriate histopathological data on the thyroid parenchyma. Results: Among the patients included, 10 had normal thyroid parenchyma, 1 had Hashimoto thyroiditis, and 1 had diffuse hyperplasia. The common MRI features of normal thyroid parenchyma include iso-/slightly high and homogeneous signal intensity on T1/T2-weighted images, normal anteroposterior diameter of the thyroid gland, smooth margin, and homogeneously increased enhancement as compared to adjacent muscle. Hashimoto thyroiditis exhibited high and inhomogeneous signal intensity on T2-weighted images, while diffuse hyperplasia revealed an increased anteroposterior diameter and lobulated margin of the thyroid gland, and inhomogeneous enhancement. Conclusions: MRI may be helpful for detection of incidental DTD.
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Affiliation(s)
- Taewoo Kang
- Department of Surgery (Busan Cancer Center), Pusan National University Hospital, Pusan National University College of Medicine, Busan, South Korea
| | - Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
- *Correspondence: Dong Wook Kim
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Young Jun Cho
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Soo Jin Jung
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ha Kyoung Park
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Tae Kwun Ha
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Do Hun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ji Sun Park
- Department of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sung Ho Moon
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
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Su Z, Duan Z, Pan W, Wu C, Jia Y, Han B, Li C. Predicting extracapsular spread of head and neck cancers using different imaging techniques: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016; 45:413-21. [DOI: 10.1016/j.ijom.2015.11.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/22/2015] [Accepted: 11/27/2015] [Indexed: 02/06/2023]
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Straetmans J, Vent J, Lacko M, Speel EJ, Huebbers C, Semrau R, Hoebers F, Mujagic Z, Klussmann JP, Preuss SF, Kremer B. Management of neck metastases of unknown primary origin united in two European centers. Eur Arch Otorhinolaryngol 2014; 272:195-205. [DOI: 10.1007/s00405-014-2934-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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Can extranodal spread in head and neck cancer be detected on MR imaging. Oral Oncol 2013; 49:626-33. [DOI: 10.1016/j.oraloncology.2013.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/20/2013] [Accepted: 02/22/2013] [Indexed: 11/23/2022]
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Park JM, Jung CK, Choi YJ, Lee KY, Kang JH, Kim MS, Hu HJ. The use of an immunohistochemical diagnostic panel to determine the primary site of cervical lymph node metastases of occult squamous cell carcinoma. Hum Pathol 2010; 41:431-7. [DOI: 10.1016/j.humpath.2009.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/01/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Heusner TA, Hahn S, Hamami ME, Kögel S, Forsting M, Bockisch A, Antoch G, Stahl AR. Incidental head and neck (18)F-FDG uptake on PET/CT without corresponding morphological lesion: early predictor of cancer development? Eur J Nucl Med Mol Imaging 2009; 36:1397-406. [PMID: 19305995 DOI: 10.1007/s00259-009-1113-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 03/02/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE To retrospectively determine whether increased/asymmetric FDG uptake on PET without a correlating morphological lesion on fully diagnostic CT indicates the development of a head and neck malignancy. METHODS In 590 patients (mean age 55.4 +/- 13.3 years) without a head and neck malignancy/inflammation FDG uptake was measured at (a) Waldeyer's ring, (b) the oral floor, (c) the larynx, and (d) the thyroid gland, and rated as absent (group A), present (group B), symmetric (group B1) or asymmetric (group B2). Differences between groups A and B and between B1 and B2 were tested for significance with the U-test (p < 0.05). An average follow-up of about 2.5 years (mean 29.5 +/- 13.9 months) served as the reference period to determine whether patients developed a head and neck malignancy. RESULTS Of the 590 patients, 235 (40%) showed no evidence of enhanced FDG uptake in any investigated site, and 355 (60%) showed qualitatively elevated FDG uptake in at least one site. FDG uptake values (SUV(max), mean+/-SD) for Waldeyer's ring were 3.0 +/- 0.89 in group A (n = 326), 4.5 +/- 2.18 in group B (n = 264; p < 0.01), 5.4 +/- 3.35 in group B1 (n = 177), and 4.1 +/- 1.7 in group B2 (n = 87; p < 0.01). Values for the oral floor were 2.8 +/- 0.74 in group A (n = 362), 4.7 +/- 2.55 in group B (n = 228; p < 0.01), 4.4 +/- 3.39 in group B1 (n = 130), and 5.1 +/- 2.69 in group B2 (n = 98, p = 0.01). Values for the larynx were 2.8 +/- 0.76 in group A (n = 353), 4.2 +/- 2.05 in group B (n = 237; p < 0.01), 4.0 +/- 2.02 in group B1 (n = 165), and 4.6 +/- 2.8 in group B2 (n = 72; p = 0.027). Values for the thyroid were 2.4 +/- 0.63 in group A (n = 404), 3.0 +/- 1.01 in group B (n = 186; p < 0.01), 2.6 +/- 0.39 in group B1 (n = 130), and 4.0 +/- 1.24 in group B2 (n = 56; p < 0.01). One patient developed a palatine tonsil carcinoma (group B1, SUV(max) 3.2), and one patient developed an oral floor carcinoma (group B1, SUV(max) 3.7). CONCLUSION Elevated/asymmetric head and neck FDG accumulation without a correlating morphological lesion can frequently be found and does not predict cancer development. In populations in which goitre is endemic, FDG uptake by the thyroid is common and not associated with thyroid cancer.
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Affiliation(s)
- Till A Heusner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
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Vega LG, Dipasquale J, Gutta R. Head and neck manifestations of distant carcinomas. Oral Maxillofac Surg Clin North Am 2009; 20:609-23. [PMID: 18940627 DOI: 10.1016/j.coms.2008.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Metastatic tumors to the head and neck from distant carcinomas are rare lesions that epitomize the "zebras." They represent a diagnostic and therapeutic challenge for clinicians and health providers. These lesions usually rank low in the differential diagnosis list, but a history of cancer should prompt clinicians about the possibility of a metastatic lesion from a distant carcinoma. The presence of these lesions usually represents a poor prognosis. The surgeon's role in treating these lesions is to improve or maintain the patient's quality of life, taking into consideration the overall prognosis.
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Affiliation(s)
- Luis G Vega
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Florida, Health Science Center, 653-1 West 8th Street, Jacksonville, FL 32209, USA.
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