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One patient--three head and neck primaries: nasopharyngeal, tongue and thyroid cancers.

Fareed MM, Al Amro A, Bayoumi Y, AlQahtani KH, Fatani HA, Tunio MA, Khalid F - BMC Res Notes (2013)

Bottom Line: High index of suspicion and thorough work up is essential in follow up of patients with head and neck primary cancers.The effect of field cancerization and environmental factors need to be explored in greater depths in such selected cases.However, which patients are at increased risk of triplet primaries, is still unknown.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, King Fahad Medical City, Riyadh 11525, Saudi Arabia. mfareed@kfmc.med.sa.

ABSTRACT

Background: We report a rare case of three head and neck malignancies in one patient. Squamous cell carcinoma of tongue and papillary thyroid carcinoma occurred as metachronous cancers in a patient with primary nasopharyngeal carcinoma. These three pathologically distinct malignancies of head and neck region in one patient is a rare phenomenon and is not reported so far.

Case presentation: A 60 year old Saudi female patient presented in March 2011 with locally advanced nasopharyngeal carcinoma. After completion of concurrent chemoradiation in June 2011, she developed two new primaries i-e thyroid cancer and tongue cancer in May 2012 along with recurrent nasopharyngeal carcinoma. We discuss histopathologic features, diagnostic tools and treatment modalities for this rarely existing case.

Conclusion: High index of suspicion and thorough work up is essential in follow up of patients with head and neck primary cancers. The effect of field cancerization and environmental factors need to be explored in greater depths in such selected cases. However, which patients are at increased risk of triplet primaries, is still unknown.

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Stereotactic radiation therapy for recurrent nasopharyngeal carcinoma.
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Figure 7: Stereotactic radiation therapy for recurrent nasopharyngeal carcinoma.

Mentions: On June 17th 2012, her case was discussed again in multidisciplinary tumor board meeting and the panel of experts agreed to go for surgery of three sites. On August 11th 2012, she underwent total thyroidectomy, left partial glossectomy with left lateral and central neck dissection and nasopharyngeal tumor resection. In partial glossectomy, margins were sent as fresh frozen. All the margins came out negative; except the anterior margin which showed mild to moderate dysplasia. Detailed histopathology report showed multifocal moderately differentiated squamous cell carcinoma of the tongue, 1.1 cm in maximum dimension, depth of invasion 2 mm, negative perineural and lymphovascular invasion, 0/12 lymph nodes (pT1N0). Nasopharyngeal mass was positive for undifferentiated nasopharyngeal carcinoma, WHO Grade –III, while thyroid specimen showed papillary thyroid carcinoma, conventional type, tumor size 2.2 cm in maximum dimension, positive extrathyroid extension in soft tissue, absent lymphovascular invasion, and 0/7 lymph nodes Figure 6; tumor was about 1 mm from inked resection margin (Thyroid carcinoma staged as T2N0M0). On November 13th 2012, she was given 100 milli curie (mCi) radioactive iodine. Seven-day postablation whole body scintigraphy revealed two foci of post-thyroidectomy residual functioning thyroid tissue in the neck. No distant metastatic lesions were noted. Recurrent nasopharyngeal primary was treated with stereotactic radiotherapy with total dose 60 Gy in 30 fractions that completed on January 01, 2013. Figure 7. At six months after re-irradiation she was found asymptomatic with GII late xerostomia.


One patient--three head and neck primaries: nasopharyngeal, tongue and thyroid cancers.

Fareed MM, Al Amro A, Bayoumi Y, AlQahtani KH, Fatani HA, Tunio MA, Khalid F - BMC Res Notes (2013)

Stereotactic radiation therapy for recurrent nasopharyngeal carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231545&req=5

Figure 7: Stereotactic radiation therapy for recurrent nasopharyngeal carcinoma.
Mentions: On June 17th 2012, her case was discussed again in multidisciplinary tumor board meeting and the panel of experts agreed to go for surgery of three sites. On August 11th 2012, she underwent total thyroidectomy, left partial glossectomy with left lateral and central neck dissection and nasopharyngeal tumor resection. In partial glossectomy, margins were sent as fresh frozen. All the margins came out negative; except the anterior margin which showed mild to moderate dysplasia. Detailed histopathology report showed multifocal moderately differentiated squamous cell carcinoma of the tongue, 1.1 cm in maximum dimension, depth of invasion 2 mm, negative perineural and lymphovascular invasion, 0/12 lymph nodes (pT1N0). Nasopharyngeal mass was positive for undifferentiated nasopharyngeal carcinoma, WHO Grade –III, while thyroid specimen showed papillary thyroid carcinoma, conventional type, tumor size 2.2 cm in maximum dimension, positive extrathyroid extension in soft tissue, absent lymphovascular invasion, and 0/7 lymph nodes Figure 6; tumor was about 1 mm from inked resection margin (Thyroid carcinoma staged as T2N0M0). On November 13th 2012, she was given 100 milli curie (mCi) radioactive iodine. Seven-day postablation whole body scintigraphy revealed two foci of post-thyroidectomy residual functioning thyroid tissue in the neck. No distant metastatic lesions were noted. Recurrent nasopharyngeal primary was treated with stereotactic radiotherapy with total dose 60 Gy in 30 fractions that completed on January 01, 2013. Figure 7. At six months after re-irradiation she was found asymptomatic with GII late xerostomia.

Bottom Line: High index of suspicion and thorough work up is essential in follow up of patients with head and neck primary cancers.The effect of field cancerization and environmental factors need to be explored in greater depths in such selected cases.However, which patients are at increased risk of triplet primaries, is still unknown.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, King Fahad Medical City, Riyadh 11525, Saudi Arabia. mfareed@kfmc.med.sa.

ABSTRACT

Background: We report a rare case of three head and neck malignancies in one patient. Squamous cell carcinoma of tongue and papillary thyroid carcinoma occurred as metachronous cancers in a patient with primary nasopharyngeal carcinoma. These three pathologically distinct malignancies of head and neck region in one patient is a rare phenomenon and is not reported so far.

Case presentation: A 60 year old Saudi female patient presented in March 2011 with locally advanced nasopharyngeal carcinoma. After completion of concurrent chemoradiation in June 2011, she developed two new primaries i-e thyroid cancer and tongue cancer in May 2012 along with recurrent nasopharyngeal carcinoma. We discuss histopathologic features, diagnostic tools and treatment modalities for this rarely existing case.

Conclusion: High index of suspicion and thorough work up is essential in follow up of patients with head and neck primary cancers. The effect of field cancerization and environmental factors need to be explored in greater depths in such selected cases. However, which patients are at increased risk of triplet primaries, is still unknown.

Show MeSH
Related in: MedlinePlus