Primary Lymphoepithelial Carcinoma of the Submandibular Gland in A Young Patient: A Case Report

Lymphoepithelial carcinoma (LEC) is a rare entity of malignancy. It has been associated with Epstein-Barr virus (EBV), and in regions where it is endemic, such as Southeast Asia, EBV is typically associated with nasopharyngeal carcinoma. The incidence of such malignancies in the young population is unusual. Here we report a 17-year-old with a 5-year history of a painless right submandibular mass presenting with a sudden increase in size for one month before surgery. Neck examination revealed a firm right submandibular gland measuring five by five cm, with an irregular surface, non-tender with normal overlying skin. We performed a fine needle aspiration cytology (FNAC), and he underwent computed tomography (CT) scan of the neck. He underwent a right submandibulectomy. Lymph nodes from levels I and II were also removed. The final histopathology was reported as LEC. Following this tissue diagnosis, another follow-up surgery, a modified radical neck dissection, was carried out for locoregional clearance. Postoperatively, he completed chemoradiotherapy treatment and is now on regular follow-up.

Should we really avoid fat in diet? The beneficial effects of low carbohydrate diet versus low fat diet on cardiovascular health: a systematic review and meta-analysis

Background

European Society of Cardiology and the American College of cardiology recommend a diet that is considerably low in fat (<35%) and high in carbohydrates (45–55%) for cardiovascular disease (CVD) prevention. However, recent evidence suggests that low-carbohydrate diets (LCD) can provide similar, if not, better CVD protection.

Design

Systematic review and meta-analysis

Methods

3 databases were screened until 17th of August 2020 for randomized controlled trials (RCTs). Two investigators selected studies, extracted data, and assessed risk of bias. Certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Weighted mean differences and 95% confidence intervals were calculated.

Results

25 trials with a total of 2438 patients were included. LCD resulted in greater reductions in body weight (WMD −1.93 (95% CI −2.69, −1.16) kg; p<0.0001), triglycerides (WMD −26.13 (95% CI −23.45, −14.29) mg/dL; p<0.0001), TNF-alpha (WMD −0.5 (95% CI −0.82, −0.17) pg/mL; p=0.003) and IL-6 (95% CI −2.29, −0.59) pg/mL; p=0.0009) with a greater increase in HDL-C (WMD 3.73 (95% CI 2.92, 4.54) mg/dL; p<0.ehab724.24271) and LDL-C (WMD 5.07 (95% 1.9, 8.23) mg/dL; p=0.002) compared to low fat diet (LFD). There was no statistical difference in systolic (WMD 0.5 (95% CI −1.06, 2.05) mmHg; p=0.53) and diastolic blood pressure reduction (WMD −0.22 (95% CI −1.35, 0.91) mmHg; p=0.70).

Conclusions

Obese patients with other cardiovascular risk factors assigned to an LCD achieved greater reductions in weight loss and triglycerides levels with a greater increase in HDL-C levels and a more pronounced anti-inflammatory state than patients assigned to an LFD. Hence, low carbohydrate diets could be an alternative tool for cardiovascular protection in selected patients.

Funding Acknowledgement

Type of funding sources: None.

Multiple metastatic deposits in the head and neck region from a renal cell carcinoma

Metastatic renal cell carcinoma (RCC) presenting with multiple deposits in the head and neck region is unusual. It is not uncommon for a RCC to metastasise to a distant site after years of a tumour-free period, but most of it would be expected to have a single site of deposit. We report a rare case of a patient who had a nephrectomy 10 years earlier for RCC and presented with tumours in the frontal sinus and posterior pharyngeal wall. Radiological imaging and histology confirmed metastatic RCC at both sites.