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Ferreira IV, Cattan MES, Chone CT, Antolini A, Egal ESA, Altemani A, Mariano FV. Radiation-induced osteosarcoma in the head and neck region: Case report and literature review. Oral Oncol 2025; 162:107216. [PMID: 39947009 DOI: 10.1016/j.oraloncology.2025.107216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Accepted: 02/06/2025] [Indexed: 03/05/2025]
Abstract
Radiation-induced sarcoma (RIS) is a rare but highly aggressive complication of radiotherapy, especially in the head and neck region (RIS-HN). This report describes a case of radiation-induced osteosarcoma (RIOS) in a 32-year-old woman with a history of craniopharyngioma treated with surgery and radiotherapy 13 years prior. The patient exhibited symptoms including epistaxis, diplopia, and ptosis of the right eyelid. Imaging revealed a large, inoperable tumor in the area that had received prior radiotherapy. A biopsy confirmed the diagnosis of osteosarcoma, and the patient initiated palliative chemotherapy. Unfortunately, the treatment was unsuccessful, and the patient passed away. A review of 148 RIOS cases published in the last 25 years in the literature shows that the maxilla and mandible are the most affected sites (68.86 %), with an average latency of 11.79 years. The most common primary tumor was nasopharyngeal carcinoma, treated with an average radiation dose of 61.69 Gy. The prognosis remains poor, with 72.3 % of patients dying within an average of 23 months of follow-up. This study highlights the clinical and pathological characteristics of RIOS, the importance of long-term monitoring of irradiated patients to detect and treat these tumors early, with the aim of improving patient outcomes.
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Affiliation(s)
- Iara Vieira Ferreira
- Department of Oral Diagnosis, Piracicaba School of Dentistry, University of Campinas (FOP/UNICAMP), Piracicaba, São Paulo, Brazil; Pathology Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marcelo Elias Schempf Cattan
- Pathology Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carlos Takahiro Chone
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Arthur Antolini
- Pathology Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Erika Said Abu Egal
- Biorepository and Molecular Pathology, Huntsman Cancer Institute, University of Utah (UU), Salt Lake City, UT, United States
| | - Albina Altemani
- Pathology Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernanda Viviane Mariano
- Department of Oral Diagnosis, Piracicaba School of Dentistry, University of Campinas (FOP/UNICAMP), Piracicaba, São Paulo, Brazil; Pathology Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
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Ognerubov NA, Antipova TS. Radiation-induced soft tissue sarcoma of the neck after radiation therapy for Hodgkin's lymphoma: a clinical case. JOURNAL OF MODERN ONCOLOGY 2022. [DOI: 10.26442/18151434.2022.3.201904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background. Radiation-induced malignancies are one of the long-term complications of radiation therapy, which is widely used to treat some tumors. The latency period before a second tumor develops varies from 3 to 60 years. Epithelial tumors and hemoblastoses occur after low-dose radiation therapy and sarcomas after high-dose radiation therapy.
Aim. To present a case of radiation-induced soft tissue angiosarcoma of the neck after the cure of Hodgkin's disease.
Materials and methods. A 41-year-old patient with Hodgkin's nodular lymphoma with the lymphoid predominance of stage IIIA with involvement of the right cervical and clavicular lymph nodes, mediastinum, and abdominal lymph nodes was followed-up. In 2004 the patient underwent four cycles of polychemotherapy per ABVD regimen followed by radiotherapy of the right cervical and clavicular lymph nodes and mediastinum, with a total focal dose of 40 Gy.
Results. Seventeen years after the treatment for Hodgkin's disease, including radiation therapy, the patient presented with painful swelling of the neck soft tissues in the radiation area with the transition to the anterior thoracic wall and an enlarged cervical lymph node. A lymph node dissection was performed. According to the combined positron emission tomography and X-ray computed tomography (PET/CT), histological and immunohistochemical studies, epithelioid angiosarcoma of soft tissues of the neck and thoracic wall stage IV cT2N1M1G3 with metastases to the skeleton bones, neck lymph nodes, left adrenal gland was established. Surgical treatment was not performed due to advanced disease. The patient received six cycles of polychemotherapy with doxorubicin + ifosfamide. PET/CT confirmed partial tumor regression.
Conclusion. Radiation-induced soft tissue sarcoma is a late iatrogenic complication of radiation therapy for Hodgkin's lymphoma. The tumor occurred in the radiation area. PET/CT is the method of choice in diagnosing and evaluating the extent of cancer and response to treatment. Chemotherapy, as an option for complex treatment, can achieve adequate disease control when surgery is not feasible.
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3
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Carr CM, Benson JC, DeLone DR, Diehn FE, Kim DK, Ma D, Nagelschneider AA, Madhavan AA, Johnson DR. Manifestations of radiation toxicity in the head, neck, and spine: An image-based review. Neuroradiol J 2022; 35:427-436. [PMID: 35499087 PMCID: PMC9437506 DOI: 10.1177/19714009221096824] [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] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiation therapy is an important component of treatment in patients with malignancies of the head, neck, and spine. However, radiation to these regions has well-known potential side effects, many of which can be encountered on imaging. In this manuscript, we review selected radiographic manifestations of therapeutic radiation to the head, neck, and spine that may be encountered in the practice of radiology. METHODS We conducted an extensive literature review of known complications of radiation therapy in the head, neck, and spine. We excluded intracranial and pulmonary radiation effects from our search. We selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications. RESULTS Based on our initial literature search and imaging database review, we selected cases of radiation-induced tumors, radiation tissue necrosis (osteoradionecrosis and soft tissue necrosis), carotid stenosis and blowout secondary to radiation, enlarging thyroglossal duct cysts, radiation myelopathy, and radiation-induced vertebral compression fractures. CONCLUSIONS We describe the clinical and imaging features of selected sequelae of radiation therapy to the head, neck, and spine, with a focus on those with characteristic imaging findings that can be instrumental in helping to make the diagnosis. Knowledge of these entities and their imaging findings is crucial for accurate diagnosis. Not only do radiologists play a key role in early detection of these entities, but many of these entities can be misinterpreted if one is not familiar with them.
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Affiliation(s)
- Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David R DeLone
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Dong K Kim
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Kao EY, McEwen AE, Aden JK, Schaub SK, Ricciotti RW, Mantilla JG. Clinical and Pathologic Characterization of 94 Radiation-Associated Sarcomas: Our Institutional Experience. Int J Surg Pathol 2022:10668969221105626. [PMID: 35695212 DOI: 10.1177/10668969221105626] [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: 11/16/2022]
Abstract
Radiation-associated sarcomas are an uncommon complication of therapeutic radiation. However, their prevalence has increased with the more widespread use of this treatment modality. The clinical, pathologic and genetic characteristics of radiation-associated sarcomas are not fully understood. In this study we describe the features of 94 radiation-associated sarcomas reviewed at our institution between 1993 and 2018, evaluate their overall survival (OS) and progression-free survival (PFS) outcomes, and compare them with their sporadic counterparts reviewed within the same time period. Histologic subtypes of all radiation-associated sarcomas included 31 (33%) undifferentiated sarcomas, 20 (21%) osteosarcomas, 17 (18%) angiosarcomas, 10 (11%) malignant peripheral nerve sheath tumor (MPNST), 9 (10%) leiomyosarcomas, 4 (4%) myxofibrosarcomas, and 3 (3%) rhabdomyosarcomas. Six patients had a documented cancer predisposition syndrome. The most common preceding neoplasms included adenocarcinoma (47%) and squamous cell carcinoma (19%), with a mean latency of 13 years. Multivariable Cox survival analysis demonstrated that advanced stage at diagnosis based on pT category (AJCC eighth edition) and fragmented resection were associated with worse survival outcomes. In addition, there was a statistically significant difference in PFS between radiation-associated undifferentiated sarcomas and MPNST when compared to their sporadic counterparts using the Kaplan-Meier method and Log-rank analysis. Overall, our study shows that radiation-associated sarcomas comprise a wide clinico-pathologic spectrum of disease, with a tendency for aggressive clinical behavior. This study further delineates the understanding of these uncommon diseases. Future studies are necessary to better understand the genetic and epigenetic changes that drive the differences in behavior between these tumors and their sporadic counterparts, and to offer better treatment options.
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Affiliation(s)
- Erica Y Kao
- Department of Pathology, 377811San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - Abbye E McEwen
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - James K Aden
- Graduate Medical Education, 377811San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - Stephanie K Schaub
- Department of Radiation Oncology, 7284University of Washington, Seattle, WA, USA
| | - Robert W Ricciotti
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Jose G Mantilla
- Department of Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
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Lou J, Jiang L, Dai X, Wang H, Yang J, Guo L, Fang M, Wang S. Radiation-Induced Sarcoma of the Head and Neck Following Radiotherapy for Nasopharyngeal Carcinoma: A Single Institutional Experience and Literature Review. Front Oncol 2021; 10:526360. [PMID: 33552942 PMCID: PMC7858657 DOI: 10.3389/fonc.2020.526360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background and Objective Radiotherapy (RT) is the primary treatment option for nasopharyngeal carcinoma (NPC), but it is associated with radiation-induced sarcomas (RISs). This study aims to investigate clinicopathological features and head and neck RIS prognosis after NPC RT. Methods The medical and radiological records of the NPC patients (n =14,074) referred to Zhejiang Cancer Hospital, Hang Zhou, China between January 1995 and December 2018 were retrospectively reviewed. Among them, 22 patients were determined to have RIS after RT for NPC. The clinicopathological data, diagnosis, treatment, and follow-up results of 22 patients with RIS were analyzed in this retrospective research. All 22 patients underwent surgery as the main treatment. The levels of Overall Survival (OS) were determined through the Log-rank test and Kaplan-Meier method. Results Among these patients, 13 were males and nine females with the male/female ratio of 1.44:1. The age during the primary RT of NPC ranged from 25 to 61 years old (median age: 37 years old). Patients' ages ranged from 33 to 73 years old (median age: 52.5 years old) when diagnosed with RIS. The latency period for development of the RIS was between 3 and 36 years (median: 8.5 years) after RT. In this cohort, R0 resection was achieved in 13 cases, R1 resection in five cases, and R2 resection in four cases. During the follow-up period ranged from 2 to 102 months (median 14 months), 15 patients had died of the disease. Kaplan-Meier method showed that the 2-year, 3-year, and the 5-year cumulative OS rate was 50.3, 43.2, and 14.4%, respectively. The median survival time was 34 months. Surgical resection with R0 resection achieves a significantly better prognosis (P = 0.012). Patients under the age of 37 years old at the time of initial RT had a relatively better prognosis (P = 0.035). Conclusions Although the incidence of RIS after RT of NPC is generally low, the treatment of RIS is very difficult. The RISs are associated with poor overall prognosis. R0 resection can improve the prognosis thus it should be considered as the primary and optimal choice for the treatment of RIS.
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Affiliation(s)
- Jianlin Lou
- Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Lin Jiang
- Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xinshen Dai
- Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Zhejiang Chinese Medical University, Hangzhou, China
| | - Huanhuan Wang
- Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia Yang
- Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Zhejiang Chinese Medical University, Hangzhou, China
| | - Liang Guo
- Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Meiyu Fang
- Department of Medical Oncology, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Shengye Wang
- Department of Radiotherapy, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
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Coca-Pelaz A, Mäkitie AA, Strojan P, Corry J, Eisbruch A, Beitler JJ, Nuyts S, Smee R, Langendijk JA, Mendenhall WM, Piazza C, Rinaldo A, Ferlito A. Radiation-Induced Sarcomas of the Head and Neck: A Systematic Review. Adv Ther 2021; 38:90-108. [PMID: 33184778 PMCID: PMC7854400 DOI: 10.1007/s12325-020-01556-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION As a result of the increased use of radiotherapy (RT) and improved long-term overall survival of patients with cancers of the head and neck (HN), the frequency of radiation-induced sarcomas of the head and neck (RISHN) may be increasing. The main objective of this systematic review was to determine the existing evidence on the frequency, treatment, and outcome of RISHN. METHODS Using PRISMA guidelines we conducted a systematic review of the literature published from 2000 to 2020. RESULTS Our review includes data of 560 patients from 64 articles. The total frequency of RISHNs among the reviewed series was 0.15%. The most frequent location of the primary tumor treated by RT was the nasopharynx. The mean RT dose used was 62 Gy, mean latency interval between irradiation and occurrence of RISHN was 11.1 years, and the most common RISHN location was the sinonasal region. Osteosarcoma was the principal histology, followed by fibrosarcoma. Surgery was the most frequently applied treatment modality. Of all patients with RISHN, 40.7% died of this disease after a mean interval of 13.9 months. CONCLUSIONS Notwithstanding the increased use of RT, the number of reported RISHNs has not increased substantially during the past two decades. Surgery with wide margins forms the best therapeutic option for these cases, but the outcome remains poor.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Asturias, Spain.
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - June Corry
- Division Radiation Oncology, Department of Medicine, St. Vincent's Hospital/The University of Melbourne, Melbourne, VIC, Australia
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of MI Hospitals-Michigan Medicine, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandra Nuyts
- Department of Oncology, Radiation-Oncology, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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de Souza LL, Pontes HAR, Santos-Silva AR, Fernandes LA, Batista LAL, Lopes MA, Khan W, Pontes FSC. Oral radiation-induced sarcomas: Systematic review. Head Neck 2020; 42:2660-2668. [PMID: 32343457 DOI: 10.1002/hed.26176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The aim of this study was to integrate the available data published on radiation-induced sarcoma of the oral cavity into an analysis of its clinical features, treatment modalities and prognostic factors. METHODS An electronic search was undertaken in September 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis. RESULTS Forty-two publications with 122 radiation-induced sarcoma of the oral cavities (RISOCs) were included. The mean latency period was 114 months and mean radiation total dose was 62.5 Gy. The tumors were more prevalent in males between 50 and 60 years old and the mandible was the most affected site. Osteosarcoma was the most prevalent histological type and patients were mostly treated with radical surgery. CONCLUSIONS RISOC showed a poor survival rate of 15.1% in 5-year follow-up. Gender and histological type were independently associated with survival.
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Affiliation(s)
- Lucas L de Souza
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Pará, Brazil
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Hélder A R Pontes
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Pará, Brazil
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Alan R Santos-Silva
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Lais A Fernandes
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Pará, Brazil
| | - Luana A L Batista
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Pará, Brazil
| | - Márcio A Lopes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Waqas Khan
- The School of Clinical Dentistry, Sheffield, UK
| | - Flávia S C Pontes
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Pará, Brazil
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8
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Gillespie J. Imaging of the post-treatment neck. Clin Radiol 2020; 75:794.e7-794.e17. [PMID: 32690240 DOI: 10.1016/j.crad.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
Post-treatment imaging of the neck is complex. It is important to have an understanding of the expected treatment related appearances as well as the possible complications. Common findings after radiation therapy include generalised soft-tissue oedema and thickening of the skin and platysma muscle. There are a number of complications of radiation that may be seen on imaging, including osteoradionecrosis, chondronecrosis, and accelerated atherosclerosis. Surgical procedures are variable depending on the primary tumour site and extent. The use of flap reconstructions can further complicate the imaging appearances. Any new nodule of enhancement or bone/cartilage erosion should raise concern for tumour recurrence. It is also important to assess for nodal recurrence. A standardised approach to reporting may help to increase accuracy and guide treatment decisions.
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Affiliation(s)
- J Gillespie
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia; Faculty of Medicine, University of Queensland, Level 6, Oral Health Centre, Herston Road, Herston, QLD, 4006 Australia.
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9
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Villemure-Poliquin N, Trudel M, Labonté S, Blouin V, Fradet G. Low-Grade Surface Osteosarcoma of the Temporal Bone in Paediatric Patients: A Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519855381. [PMID: 31263376 PMCID: PMC6595646 DOI: 10.1177/1179556519855381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/13/2019] [Indexed: 12/04/2022]
Abstract
Purpose of the study: Primary osteosarcoma of the temporal bone is an exceedingly rare pathology in the paediatric population. As of now, only 3 cases have been reported in the English literature. We describe the additional case of a 16-year-old girl with an osteosarcoma of the mastoid bone. This study aims to report a rare paediatric case of low-grade surface osteosarcoma of the temporal bone. Materials and methods used: A literature review was performed to better understand paediatric osteosarcomas of the head and neck region, to optimize their investigation, to describe their histopathological and radiological characteristics, and to establish the optimal modalities of medical and surgical treatments. The research of previous published data was done using PubMed and Embase library with the keywords mentioned below. Results: The patient presented with a rapidly progressive left retroauricular lesion over a 3-week period. Radiological studies demonstrated aggressive and invasive features. An open biopsy followed and confirmed the diagnosis of a low-grade surface osteosarcoma. In accordance with the multidisciplinary team, we decided to perform a complete surgical resection with wide surgical margins. We did not administer any adjuvant therapies. A control computed tomography (CT) scan obtained 26 months postoperatively still showed no signs of recurrence. Conclusion: Osteosarcomas are aggressive malignant neoplasms found in the head and neck region in only 6% to 10% of cases. They represent approximately 1% of head and neck cancers, and these are generally high-grade lesions. Temporal bone involvement is rare, particularly for low-grade lesions in paediatric patients. In addition to reporting the fourth paediatric case of primary temporal bone osteosarcoma, this study describes its specific clinical, histopathological, and radiological findings, to improve the management and the prognostic of patients affected with this particular clinical entity.
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Affiliation(s)
- Noémie Villemure-Poliquin
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Mathieu Trudel
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Sebastien Labonté
- Department of Pathology, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Valérie Blouin
- Department of Radiology, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Gaétan Fradet
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
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10
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Giannini L, Incandela F, Fiore M, Gronchi A, Stacchiotti S, Sangalli C, Piazza C. Radiation-Induced Sarcoma of the Head and Neck: A Review of the Literature. Front Oncol 2018; 8:449. [PMID: 30386739 PMCID: PMC6199463 DOI: 10.3389/fonc.2018.00449] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022] Open
Abstract
In the last decades, radiotherapy (RT) has become one of the cornerstones in the treatment of head and neck (HN) malignancies and has paralleled an increase in long-term patient survival. This lead to a concomitant increase in the incidence of radiation-induced sarcomas (RIS) of the irradiated field, with an annual rate up to 0.17%. The new techniques of irradiation do not seem to influence the risk of RIS of the HN (RISHN), which mainly develop within the middle-dose field. The median latency of RISHN after RT is 10–12 years and osteosarcoma is the most represented histotype, even though there is a high variability in time of occurrence and histological features observed. There is no clear evidence of predisposing factors for RISHN, and genetic findings so far have not revealed any common mutation. Early clinical diagnosis of RISHN is challenging, since it usually occurs within fibrotic and hardened tissues, while radiological findings are not pathognomonic and able to differentiate them from other neoplastic entities. Given the highly aggressive behavior of RISHN and its poor sensitivity to chemotherapy, radical surgery is the most important prognostic factor and the only curative option at present. Nevertheless, the anatomy of the HN district and the infiltrative nature of RIS do not always allow radical intervention. Therefore, a wise integration with systemic therapy and, when feasible, re-irradiation should be performed. Future findings in the genomic features of RISHN will be crucial to identify a possible sensitivity to specific drugs in order to optimize a multimodal treatment that will be ideally complementary to surgery and re-irradiation.
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Affiliation(s)
- Lorenzo Giannini
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology-Head and Neck Surgery, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Sarcoma Unit, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Silvia Stacchiotti
- Adult Mesenchymal and Rare Tumor Medical Oncology Unit, Department of Medicine, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Claudia Sangalli
- Department of Radiotherapy, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy
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11
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Williams L, Tmanova L, Mydlarz WK, Page B, Richmon JD, Quon H, Schmitt NC. Radiation-Associated Sarcoma of the Neck: Case Series and Systematic Review. Ann Otol Rhinol Laryngol 2018; 127:735-740. [PMID: 30047787 DOI: 10.1177/0003489418789966] [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: 12/28/2022]
Abstract
INTRODUCTION Radiation-associated soft tissue sarcomas of the neck (RASN) constitute a rare and aggressive tumor type. METHODS A retrospective chart review at the authors' institution revealed 3 patients with RASN. A systematic review of the literature was also conducted using MEDLINE, Ovid, the Cochrane Library, and Embase. RESULTS Patients within the authors' institutional chart review presented from 6 to 26 years after neck radiation with neck masses. All patients underwent surgical resection with clear margins, and adjuvant radiation was offered when feasible. Patients had no evidence of disease at most recent follow-up. A total of 867 articles were screened for systematic review, revealing 9 articles detailing outcomes of RASN. Studies were small and heterogeneous, precluding pooled data. The importance of complete surgical extirpation was noted. CONCLUSIONS Complete surgical resection appears to be the mainstay of therapy, but there are limited data on management and outcomes of patients with RASN.
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Affiliation(s)
- Lawrence Williams
- 1 Department of Otolaryngology - Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Lyubov Tmanova
- 1 Department of Otolaryngology - Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Wojciech K Mydlarz
- 2 Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.,3 Head and Neck Surgery Branch, National Institute of Deafness and Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Brandi Page
- 4 Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy D Richmon
- 5 Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Harry Quon
- 4 Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Nicole C Schmitt
- 2 Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.,3 Head and Neck Surgery Branch, National Institute of Deafness and Communication Disorders, National Institutes of Health, Bethesda, MD, USA
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Kanda T, Wakabayashi Y, Zeng F, Ueno Y, Sofue K, Maeda T, Nogami M, Murakami T. Imaging findings in radiation therapy complications of the central nervous system. Jpn J Radiol 2018; 36:519-527. [PMID: 30043344 DOI: 10.1007/s11604-018-0759-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/17/2018] [Indexed: 01/24/2023]
Abstract
Radiation therapy is a useful treatment for tumors and vascular malformations of the central nervous system. Radiation therapy is associated with complications, including leukoencephalopathy, radiation necrosis, vasculopathy, and optic neuropathy. Secondary tumors are also often seen long after radiation therapy. Secondary tumors are often benign tumors, such as hemangiomas and meningiomas, but sometimes malignant gliomas and soft tissue sarcomas emerge. We review the imaging findings of complications that may occur after brain radiation therapy.
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Affiliation(s)
- Tomonori Kanda
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Yuichi Wakabayashi
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Feibi Zeng
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshiko Ueno
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takaki Maeda
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Zhu W, Hu F, Zhao T, Wang C, Tao Q. Clinical Characteristics of Radiation-Induced Sarcoma of the Head and Neck: Review of 15 Cases and 323 Cases in the Literature. J Oral Maxillofac Surg 2015; 74:283-91. [PMID: 26275593 DOI: 10.1016/j.joms.2015.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE This retrospective study aimed to identify the clinical characteristics of radiation-induced sarcoma of the head and neck (RISHN) that could help in the early diagnosis of this rare disease. MATERIALS AND METHODS From August 1995 through October 2014, 15 cases of RISHN presenting at the authors' department and 323 cases in the literature were reviewed. RESULTS The incidence of RISHN was higher in men than in women (male-to-female ratio, 2.4:1). The mean latency was long (9.3 yr), and the tumor often occurred in middle age (50.0 yr old). Osteosarcoma was the predominant pathologic diagnosis (34.1%). The prognosis of RISHN was poor. CONCLUSION RISHN is a serious long-term complication of radiotherapy and its incidence has been increasing in recent years. Owing to the long latency period, its early diagnosis is difficult to make. RISHN should be considered when a patient who has undergone radiotherapy presents with a mass, pain, or trismus in the irradiated field.
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Affiliation(s)
- Wangyong Zhu
- Resident, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fengchun Hu
- Resident, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tengda Zhao
- Resident, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cheng Wang
- Attending Physician and Associate Professor, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qian Tao
- Attending Physician and Professor, Department of Oral Maxillofacial-Head and Neck Oncology, Affiliated Hospital of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Zhang X, Bai S, Li H, Hu H, Duan X, Chen M, Wang D, Chen Y, Zhang F, Shen J. CT and MRI findings of radiation-induced external auditory canal carcinoma in patients with nasopharyngeal carcinoma after radiotherapy. Br J Radiol 2015; 88:20140791. [PMID: 25827205 PMCID: PMC4628451 DOI: 10.1259/bjr.20140791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/19/2015] [Accepted: 03/31/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To summarize the radiological and clinical features of radiation-induced external auditory canal carcinomas (RIEACCs) in patients with nasopharyngeal carcinomas (NPCs) after radiation therapy. METHODS CT, MRI and clinical features in 16 patients with histologically proven RIEACCs were retrospectively reviewed. There were 2 females and 14 males, with a median age of 52.5 years at the time of diagnosis of RIEACC. Imaging parameters including lesion extent, size, margin, shape, bone destruction, adjacent structure invasion, density/signal intensity, and pattern and degree of enhancement were assessed. Clinical features including clinical staging, histological type, treatment and radiation dose (RD) of primary NPC as well as the histological type, staging of radiation-induced tumour and the latent period between NPC and RIT were recorded. RESULTS All patients had a single RIEACC. The lesions had a size of 3.5 ± 1.4 cm and were localized (n = 7) or extensive (n = 9). Most of the lesions were partially or ill defined with an irregular shape and had an intermediate density/signal pattern and moderate homogeneous enhancement. The latent period of RIEACCs ranged from 10 to 20 years in nine patients with a RD of 68-70 Gy; from 2 to 10 years in five patients with a RD of 68-74 Gy; and more than 20 years in two patients with a RD of 70 or 72 Gy. CONCLUSION An external auditory canal (EAC) mass with homogeneous, intermediate CT density or signal intensity in patients with NPC after radiotherapy is highly suggestive of RIEACC, which should be included in the routine surveillance for patients with NPC after radiotherapy. ADVANCES IN KNOWLEDGE RIEACCs could occur as short as 2 years after radiotherapy in patients with NPC and have distinct features from otitis media and sarcomas. This EAC malignancy should be included in routine surveillance for patients with NPC after radiotherapy.
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Affiliation(s)
- X Zhang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - S Bai
- Department of Radiotherapy, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - H Li
- Department of Radiology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - H Hu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - X Duan
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - M Chen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - D Wang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Y Chen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - F Zhang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - J Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Scott SJ, Salgaonkar V, Prakash P, Burdette EC, Diederich CJ. Interstitial ultrasound ablation of vertebral and paraspinal tumours: parametric and patient-specific simulations. Int J Hyperthermia 2015; 30:228-44. [PMID: 25017322 DOI: 10.3109/02656736.2014.915992] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Theoretical parametric and patient-specific models are applied to assess the feasibility of interstitial ultrasound ablation of tumours in and near the spine and to identify potential treatment delivery strategies. METHODS 3D patient-specific finite element models (n = 11) of interstitial ultrasound ablation of tumours associated with the spine were generated. Gaseous nerve insulation and various applicator configurations, frequencies (3 and 7 MHz), placement trajectories, and tumour locations were simulated. Parametric studies with multilayered models investigated the impacts of tumour attenuation, tumour dimension, and the thickness of bone insulating critical structures. Temperature and thermal dose were calculated to define ablation (>240 equivalent minutes at 43 °C (EM43 °C)) and safety margins (<45 °C and <6 EM43 °C), and to determine performance and required delivery parameters. RESULTS Osteolytic tumours (≤44 mm) encapsulated by bone could be successfully ablated with 7 MHz interstitial ultrasound (8.1-16.6 W/cm(2), 120-5900 J, 0.4-15 min). Ablation of tumours (94.6-100% volumetric) 0-14.5 mm from the spinal canal was achieved within 3-15 min without damaging critical nerves. 3 MHz devices provided faster ablation (390 versus 930 s) of an 18 mm diameter osteoblastic (high bone content) volume than 7 MHz devices. Critical anatomy in proximity to the tumour could be protected by selection of appropriate applicator configurations, active sectors, and applied power schemas, and through gaseous insulation. Preferential ultrasound absorption at bone surfaces facilitated faster, more effective ablations in osteolytic tumours and provided isolation of ablative energies and temperatures. CONCLUSIONS Parametric and patient-specific studies demonstrated the feasibility and potential advantages of interstitial ultrasound ablation treatment of paraspinal and osteolytic vertebral tumours.
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Affiliation(s)
- Serena J Scott
- Thermal Therapy Research Group, Department of Radiation Oncology, University of California , San Francisco , California
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Radiation-induced sarcoma masquerading as osteoradionecrosis: case report and literature review. The Journal of Laryngology & Otology 2015; 129:279-82. [DOI: 10.1017/s0022215114003326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractBackground:Radiation therapy is a commonly used treatment in head and neck oncology, whether used alone or as an adjunct to other treatments. Osteoradionecrosis and radiation-induced malignancy are both rare, late complications of radiation therapy.Methods:This paper describes a case of radiation-induced sarcoma of the mandible initially presenting as osteoradionecrosis. In addition, the literature on the identification and treatment of these entities is reviewed.Results:The patient underwent excision and reconstruction of the presumed osteoradionecrosis. Final pathology demonstrated radiation-induced sarcoma. The patient suffered tumour recurrence at seven months post-operatively.Conclusion:When evaluating a patient with osteoradionecrosis, clinicians should be cognisant of the risk of malignancy. This paper describes the first case of radiation-induced sarcoma presenting as osteoradionecrosis. Primary treatment of radiation-induced sarcoma is wide surgical extirpation, with a very limited role for chemotherapy. Overall survival for this entity is poor.
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Thiagarajan A, Iyer NG. Radiation-induced sarcomas of the head and neck. World J Clin Oncol 2014; 5:973-981. [PMID: 25493233 PMCID: PMC4259957 DOI: 10.5306/wjco.v5.i5.973] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/28/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
With improved outcomes associated with radiotherapy, radiation-induced sarcomas (RIS) are increasingly seen in long-term survivors of head and neck cancers, with an estimated risk of up to 0.3%. They exhibit no subsite predilection within the head and neck and can arise in any irradiated tissue of mesenchymal origin. Common histologic subtypes of RIS parallel their de novo counterparts and include osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma/sarcoma nitricoxide synthase, and fibrosarcoma. While imaging features of RIS are not pathognomonic, large size, extensive local invasion with bony destruction, marked enhancement within a prior radiotherapy field, and an appropriate latency period are suggestive of a diagnosis of RIS. RIS development may be influenced by factors such as radiation dose, age at initial exposure, exposure to chemotherapeutic agents and genetic tendency. Precise pathogenetic mechanisms of RIS are poorly understood and both directly mutagenizing effects of radiotherapy as well as changes in microenvironments are thought to play a role. Management of RIS is challenging, entailing surgery in irradiated tissue and a limited scope for further radiotherapy and chemotherapy. RIS is associated with significantly poorer outcomes than stage-matched sarcomas that arise independent of irradiation and surgical resection with clear margins seems to offer the best chance for cure.
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Imaging findings of recurrent tumors after orbital exenteration and free flap reconstruction. Ophthalmic Plast Reconstr Surg 2014; 30:315-21. [PMID: 24867414 DOI: 10.1097/iop.0000000000000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Tumors that recur following orbital exenteration may not be evident on clinical examination, highlighting the need for imaging surveillance. The goal of this study was to report the imaging characteristics of recurrent tumors following orbital exenteration and free flap reconstruction. METHODS The authors retrospectively reviewed the records of 48 patients who underwent orbital exenteration for the treatment of orbital malignancy and identified 17 recurrent tumors in 17 patients. The lesions were assessed for the presence of a soft tissue mass, imaging characteristics, and fluorodeoxyglucose avidity. RESULTS The recurrent tumors were detected 1 month to 6 years 10 months (median, 1 year 3 month) after orbital exenteration. On both CT and MRI, all 17 lesions were soft tissue masses at presentation. On CT, the lesions demonstrated heterogeneous to homogeneous to centrally necrotic enhancement; on MRI, the lesions were T1 hypointense to isointense and T2 hypointense to hyperintense. Twelve of the 15 recurrent tumors with available preoperative imaging had an enhancing appearance similar to that of the original tumor. Thirteen of the 17 recurrent tumors were at the margin of a flap placed for reconstruction; the other 4 lesions were remote from the operative site. CONCLUSION Recurrent tumors following orbital exenteration and free flap reconstruction demonstrate a wide range of imaging appearances but most often appear as a soft tissue masses often similar in appearance to the primary tumor and arising near the flap margin. Awareness of the imaging features of recurrent disease is important because failure to diagnose recurrence can delay appropriate treatment.
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Hadley C, Gressot LV, Patel AJ, Wang LL, Flores RJ, Whitehead WE, Luerssen TG, Jea A, Bollo RJ. Osteosarcoma of the cranial vault and skull base in pediatric patients. J Neurosurg Pediatr 2014; 13:380-7. [PMID: 24483254 DOI: 10.3171/2013.12.peds13359] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cranial osteosarcoma is very rare in children, rendering the development of optimal treatment algorithms challenging. The authors present 3 cases of pediatric cranial osteosarcoma: a primary calvarial tumor, a cranial metastasis, and a primary osteosarcoma of the cranial base. A review of the literature demonstrates significant variation in the management of cranial osteosarcomas and the outcome for patients with these tumors. This series and literature review is presented to improve the understanding of pediatric cranial osteosarcoma and to reinforce the importance of maximal resection in optimizing outcome.
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Affiliation(s)
- Caroline Hadley
- Department of Neurosurgery, Baylor College of Medicine and Division of Pediatric Neurosurgery, Texas Children's Hospital
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Lubek JE, Dyalram D, Perera EH, Liu X, Ord RA. A Retrospective Analysis of Squamous Carcinoma of the Buccal Mucosa: An Aggressive Subsite Within the Oral Cavity. J Oral Maxillofac Surg 2013; 71:1126-31. [DOI: 10.1016/j.joms.2012.12.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/29/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
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Olson MT, Wakely PE, Weber K, Siddiqui MT, Ali SZ. Postradiation sarcoma: morphological findings on fine-needle aspiration with clinical correlation. Cancer Cytopathol 2012; 120:351-7. [PMID: 22517661 DOI: 10.1002/cncy.21200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/02/2012] [Accepted: 03/09/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current study was conducted to describe the clinical features and presentation, cytomorphological characteristics with histological correlation, and prognosis of patients who undergo fine-needle aspiration (FNA) for postradiation sarcoma (PRS). METHODS A retrospective review was performed of 13 individual patients who were pooled from the FNA services of 3 academic institutions between 2001 and 2012. Cases were reviewed for the primary tumor, radiation history, latency period, and other distinguishing clinical features. The frequency of the various cytological preparations as well as the use of immunohistochemistry (IHC) on this material were reviewed. The cytopathology diagnosis was compared with the resection diagnosis, and the survival time was reviewed. RESULTS The median age of the patients was 61 years (range, 35 years-94 years) and no significant gender predilection was noted. The median latency period was 11 years (range, 5 years to > 50 years). Patients generally presented with large tumors (median, 8 cm [range, 3 cm-12 cm]), and the median survival was 14 months (range, 6 months-46 months). Nine of 13 patients died of their disease and 1 was lost to follow-up. The tumors were morphologically heterogeneous. IHC played an important role in excluding other diagnoses in those cases in which sufficient material was available. CONCLUSIONS PRS is a morphologically heterogeneous entity that can be diagnosed by FNA. It is a diagnosis of exclusion that requires a history of therapeutic radiation and often requires IHC to rule out locally recurrent malignancy.
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Affiliation(s)
- Matthew T Olson
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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