Kocuria kristinae - An unusual opportunistic pathogen in head and neck malignancy: Case series from central India's regional cancer care centre

Introduction: Kocuria kristinae is a commensal organism, sometimes considered as a lab contaminant, but its repeated isolation from clinical samples in immunocompromised patients should raise red flags. Materials and Methods: We confirmed the infection with re-isolation of the organism from the same site before starting treatment. For the identification of Kocuria kristinae we used IDGP cards on VITEK 2 compact system. Antibiotic susceptibility test was done manually following CLSI guidelines 2018 for Coagulase-negative staphylococci. Results: A total of 510 major head neck oncosurgeries were performed during the period of two years. Out of which 120 patients had skin and soft tissue infections. Out of these infected patients, 90 were culture positive and of these Kocuria kristinae were isolated in 12 patients. Resistance to penicillin and oxacillin is seen in all isolates. Conclusion: Kocuria kristinae should not be ignored as a commensal flora or lab contaminant in immunocompromised hosts. Its Increase in resistance pattern is a matter of concern. It is an ignored opportunistic pathogen whose detailed sensitivity test should be developed to treat patients timely and effectively.

The impact of multimodality integrated positron emission tomography-computed tomography on improving the staging and management of head and neck malignancy: a cross- sectional study

ABSTRACT BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.

Synchronous papillary thyroid carcinoma with metastatic nasopharyngeal carcinoma issues regarding its diagnosis and management

@#A 46-year old female presented with a one-year history of a right lateral neck mass which gradually increased in size and subsequently involved bilateral cervical nodes. Diagnosed as Papillary Thyroid Carcinoma Stage I (T1N2M0), she underwent Total Thyroidectomy, Central Neck Dissection, Modified Radical Neck Dissection, Type I, right and Modified Radical Neck Dissection Type III, left. Histopathology revealed papillary thyroid carcinoma with no lymphovascular and capsular invasion, and metastatic undifferentiated carcinoma in 15 out of 16 lymph nodes, probably nasopharyngeal in origin. Work up uncovered an erythematous, friable nasopharyngeal mass. Its histopathology was nasopharyngeal cancer, a second primary malignancy. The malignancies were treated as separate entities. The patient underwent chemoradiotherapy first for the nasopharyngeal cancer. Radioactive Iodine for the thyroid malignancy was given six months after completion of radiotherapy. Double primary malignancies deserve aggressive treatment. The sequence of therapy should be based on the severity of the malignancy.

Percutaneous Endoscopic Gastrostomy Through the Sinus Tract of a Surgical Gastrostomy

We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.

Photodynamic Therapy for Recurrent Head and Neck Malignancy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a preliminary study, authors tried to verify clinical and side effects of Radachlorin in a photodynamic therapy for recurrent head and neck malignancy. Radachlorin shows an absorption peak at 662 nm, which indicates that it penetrates up to 10 mm. SUBJECTS AND METHOD: We treated 12 sites for 9 treatments in 6 recurrent head and neck malignacies, 4 cases of squamous cell cancers and each of adenoid cystic cancer, and undifferentiated nasopharyngeal cancer. A dose of 1 mg/kg or 2-5 mL of Radachlorin was i.v. injected into the mass according to the mass size. We used a diode laser, MILON-662 (Milon Laser Company, Russia) and Medlight cylindrical 10/20 radial diffuser and frontal diffuser as light delivery devices. About 3 hrs after intravenous injection, or 30 min after intralesional injection, a light dose of 200-300 J/cm2 or cm of laser was irradiated onto the tumor or intralesionally with the light dose of 200-300 J/cm2, or cm. RESULTS: There was partial tumor regression in three of the five primary tumors. In one case of metastatic node treated by intralesional injection and irradiation, tumor showed complete necrosis. But there was no effect in 2 cases of subcutaneous metastases. There were no side effects such as fever, chill and photosensitivity in any of the cases. CONCLUSION: The clinical effect of photodynamic therapy (PDT) using Radachlorin with 662 nm of laser light is not clear yet, but it seems to be a safe treatment for head and neck malignancy. We need to investigate the effect of this PDT system in untreated head and neck malignancies.