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Query: UMLS:C0006826 (cancer)
 1,092,456 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Port-A-Cath systems are widely used for long-term therapy in the treatment of malignancies and infection. Spontaneous migration of Port-A-Cath catheters after satisfactory initial placement is uncommon but is associated with a number of complications, including neck pain, shoulder pain, ear pain, infection, venous thrombosis, and neurological complications. We describe two cases of migration of the Port-A-Cath catheter into the ipsilateral internal jugular vein. Both received surgical reposition of the catheter with a longer one. We speculate that the migration is related to severe cough and vigorous changes of intrathoracic pressure. We also review the literature regarding such unusual complications of Port-A-Cath. Because catheter migration might be asymptomatic, monitoring the catheter position bimonthly when not used is recommended. Before a new course of chemotherapy or encountering symptoms of migration, obtaining a chest roentgenogram is essential to provide early detection and repositioning management of a migrated catheter.
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PMID:Spontaneous migration of a Port-a-Cath catheter into ipsilateral jugular vein in two patients with severe cough. 1601 May 3

Patients referred from an otorhinolaryngologist with a chief complaint of earache or other ear symptoms are common in a temporomandibular disorders (TMD) clinic. These patients often complain of other symptoms, such as headache, facial pain, and limited mouth opening, all of which can be present in a patient suffering from a nasopharyngeal carcinoma (NPC). The aim of this case report was to describe the signs and symptoms of NPC and discuss possible causes for the misdiagnosis of NPC as TMD. The characteristics of 8 NPC patients reported in the literature whose cancer was initially misdiagnosed as TMD and those of an NPC patient with TMD-like symptoms treated at the clinic of 1 of the authors are described, and the reasons for misdiagnosis are discussed. A revision of Trotter's syndrome for the differential diagnosis of TMD is proposed. There is a need for detailed exclusion criteria to be applied prior to the assignment of a clinical diagnosis based on the Research Diagnostic Criteria for TMD.
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PMID:Nasopharyngeal carcinoma mimicking a temporomandibular disorder: a case report. 1648 23

Many patients who present with otalgia have a normal otological examination, and a distant source of pain must be considered. The ear receives an extensive sensory innervation arising from six nerve roots. Many other structures in the head, neck and thorax share a common neuronal pathway with the ear, and these tissues represent the possible sites of disease in the cases of referred otalgia. Consequently, the differential diagnosis is extensive and varied. Making an accurate diagnosis relies on an understanding of the complex distribution of nerve fibres and a structured approach to patient assessment. This article aims to classify the aetiology of referred otalgia and to outline current treatments for these conditions. The origins of referred otalgia may be as remote as the cranial cavity and thorax; however, dental disease, tonsillitis, temporomandibular joint disorders and cervical spine pathology represent the most frequent causes. Ear pain may also be the first sign of a head and neck malignancy. Patients complaining of otalgia, with risk factors for an aerodigestive neoplasm, and a normal ENT examination require an urgent otolaryngological opinion.
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PMID:Referred otalgia: a structured approach to diagnosis and treatment. 1750 63

Jugulo-tympanic paraganglioma is the most commonly recognized neoplasia involving the middle ear, arising from chemopressure receptors. Clinical presentation is variable, with otalgia, dizziness and cranial nerve palsies. This tumor usually occurs in middle aged women and its presentation may be familiar, sporadic, bilateral or multicentric. In the present case the patients presented with otalgia and bradyacusia diagnosed with chronic otitis. A bleeding polypoid lesion in middle ear was seen during surgery. Frozen section of intraoperative specimen showed monomorphic cells organized into nests, without aspects of malignancy, into a highly vascularized stroma. Immunohistochemical analysis revealed two type of cells: chief cells immunostained for chromogranin and synaptophysin and sustentacular cells immunostained for S-100 protein. Clinical presentation of jugulotympanic paraganglioma, when it isn't associated with evidence of hormone secretion, is referred prevalently to bradyacusia, dizziness, and cranial nerve palsies. In event of localized disease, paragangliomas often can be treated by surgical excision, but some cases need radiation therapy.
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PMID:[Jugulotympanic paraganglioma]. 1798 28

Extracranial spread of recurrent meningiomas involving the middle ear is rare. We present the case of a 59-year-old woman with headache and swelling of scalp over the right temporal region. MRI revealed a lesion in the right temporal lobe suggestive of meningioma. She underwent complete surgical excision of the lesion followed by post-operative radiotherapy. After 1 year, she presented with right-sided otalgia and a middle-ear mass extruding into the external auditory canal. She was re-operated and histopathology was anaplastic meningioma. We are discussing this unusual pattern of recurrence in our patient with a review of literature.
Indian J Cancer
PMID:An atypical presentation of recurrent temporal lobe meningioma with external auditory canal mass. 1825 May 35

Nasopharygeal amyloidosis is a rare entity described in the otolaryngology literature. It is usually isolated and does not represent a manifestation of systemic disease. Herein we discuss the first reported case of incidentally discovered nasopharyngeal amyloidosis leading to the diagnosis of systemic disease. A patient presented to the otolaryngology clinic with complaints of otalgia and eustachian tube dysfunction. He was noted to have a unilateral middle ear effusion and subsequent nasolaryngoscopy demonstrated a right nasopharyngeal mass at the eustachian tube orifice--this was biopsied and shown to be nasopharyngeal amyloidosis. Amyloidis is a condition which entails the abnormal deposition of proteins in tissue (local) and organs (systemic) throughout the body secondary to an alteration in the secondary structure of the protein into an insoluble form, termed amyloid. Amyloidosis in the head and neck most often presents in the larynx (60%), followed by the trachea (9%), orbit (4%), and nasopharynx (3%). The vast majority of these lesions represent isolated amyloidosis, which is not associated with a shortened lifespan or the sequelae associated with systemic disease. Treatment of local disease is typically excision followed by routine surveillance for recurrence. Treatment of systemic disease is complex, and should be managed by a Hematologist/Oncologist. Amyloidosis can be associated with malignancy, thus proper workup is important even when isolated lesions are discovered.
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PMID:Nasopharyngeal amyloidosis: a case report. 2122 95

Wegener's granulomatosis (WG) is an uncommon autoimmune disorder, which mainly involves the blood vessels, kidneys and respiratory tract. We report an interesting case of WG with unusual multiorgan involvement in a young male who presented with a short history of right-sided otalgia, nasal obstruction and a right parotid mass. His initial CT and MRI scans showed a large parotid mass with features suggestive of malignancy with bilateral cavitating pulmonary nodules suggesting metastatic disease. The imaging-based differential diagnosis was squamous cell carcinoma or adenoid cystic carcinoma. The microscopic findings on ultrasound-guided biopsy of the parotid mass were, surprisingly, those of acute necrotising granulomatous inflammation with some features suggestive of a vasculitic process. A multidisciplinary team discussion and further investigation resulted in the additional findings of haematuria, raised erythrocyte sedimentation rate and positive serum cytoplasmic anti-neutrophil cytoplasmic antibody test, which led to the diagnosis of WG. Subsequently, the patient developed acute urinary retention owing to gross prostatic enlargement related to further disease involvement, which was confirmed with a positive biopsy. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT scan showed disease distribution at the right maxillary sinus/nasal cavity, right parotid, mediastinum, lungs and prostate. To our knowledge, this is the first reported 18F-FDG PET/CT case with multiorgan involvement in a single WG patient. The patient has improved both clinically and on imaging after appropriate treatment with immunosuppressive therapy and steroids. Although 18F-FDG PET/CT imaging did not actually alter the management of this patient, it can help to establish the disease distribution and guide the biopsy.
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PMID:Fluorine-18-fluorodeoxyglucose PET/CT rare finding of a unique multiorgan involvement of Wegener's granulomatosis. 2193 77

An elderly gentleman presented to hospital with recurrent blackout episodes consistent with syncope and a 3-month history of right ear pain. Significant postural hypotension was recorded. White cell count and C reactive protein were elevated. MRI of the head and neck revealed a soft tissue abnormality in the right nasopharynx and base of skull. Tissue biopsies were obtained and microbiology specimens revealed a mixed growth of pseudomonas and diphtheroids. There was no histological evidence of malignancy. A diagnosis of skull base infection was made. Infective involvement of the carotid sinus was considered to be the cause of the recurrent syncope and postural hypotension. The patient responded well to a 12-week course of intravenous meropenem. Inflammatory markers returned to normal and a repeat MRI after 3 months of treatment showed significant resolution of infection. The syncopal episodes and orthostatic hypotension resolved in parallel with treatment of infection.
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PMID:Recurrent syncope and chronic ear pain. 2279 82

A sore throat, otalgia, and snoring are the common symptoms seen in children presenting to an otorhinolaryngological clinic. Sometimes, however, these symptoms may be suggestive of an aggressive malignancy. We present a rare case of Burkitt's lymphoma of the tonsil in a young child, which initially manifested as a sore throat and otalgia.
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PMID:An unusual case of a sore throat and otalgia in a 4-year-old boy. 2286 76

External auditory canal (EAC) carcinomas are frequently misdiagnosed. The aim of this study was to conduct a review of misdiagnosed cases and analyze the factors involved. This study was a retrospective assessment. Eighteen of 44 EAC carcinoma cases seen at the Eye and ENT Hospital were misdiagnosed. All medical records were retrospectively analyzed for the age, sex, presenting symptoms, type of misdiagnosis, computed tomographic (CT) or magnetic resonance imaging (MRI) findings, stage of the cancer, surgical approach, histopathological examination, adjunctive therapy (postoperative radiotherapy) and outcomes of treatment. Six cases were misdiagnosed as otitis media, five cases were misdiagnosed as otitis externa, and two cases were misdiagnosed as external auditory canal cholesteatomas. Other misdiagnoses were stenosis of the EAC, ear neuralgia, furuncle of the EAC, benign neoplasm of the EAC and pre-auricular fistula. Our analyses suggest that a biopsy should be conducted to obtain a histopathological diagnosis if an EAC carcinoma is suspected, in case otitis media or otitis externa does not respond to routine anti-bacterials. Head and neck MRI should be used to explore the involvement of soft tissues. Patients with bloody ear discharge and otalgia, particularly with temporal bone erosion seen in a CT scan, are highly likely to have a malignant carcinoma of the temporal bone.
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PMID:The misdiagnosis of external auditory canal carcinoma. 2292 89


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