Ewing Sarcoma of the Larynx with Thyroid Cartilage Destruction: A Case Report.

Ewing sarcoma of the larynx is extremely rare, only a few number of cases have been reported. In this report, we describe a case of extraskeletal Ewing sarcoma of the larynx with thyroid cartilage destruction. Laryngoscope, 2024.

[Role of MRI and CT in the evaluation of postirradiation status and complications in head and neck cancer]. / Az MRI és a CT szerepe a sugárterápia utáni státusz értékelésében, szövõdményeinek vizsgálatában, fej-nyaki daganatoknál.

Most head and neck cancer patients are treated with combined modalities such as surgery, radiotherapy (RT), chemotherapy (ChT). Concurrent chemo-radiation has improved treatment outcomes with increased toxic effects. Reactions after RT are divided into early and late changes. Early reactions are seen during the course of therapy or within 3 months; these are reversible in most cases. Late complications are observed 3 months to years after RT and they are generally irreversible. As typical late reaction radiation induced necrosis may occur in soft tissues, cartilage, bones and brain. Tumor recurrence and post-radiation necrosis typically appear at the same time, within 2-3 years after RT; the differentiation may be difficult. Computed tomography (CT) and magnetic resonance imaging (MRI) have become the gold standards not only for staging and assessing tumor response, but also to evaluate posttreatment status, to distinguish residual or recurrent tumor and RT complications. Using baseline CT or MRI between 2-3 months after treatment and performing standard follow-up imaging with strict clinical follow-up are required to establish early salvage treatment.

Impact of 3T multiparametric MRI and FDG-PET-CT in the evaluation of occult primary cancer with cervical node metastasis.

BACKGROUND: This study aimed to determine the ability of multimodal evaluation with multiparametric 3T-MRI (MPMRI) and positron emission tomography - computed tomography (PET/CT) to detect cancer of unknown primary origin (CUP) with neck lymph node (LN) metastasis. METHODS: The study group comprised 38 retrospectively analysed consecutive patients with LN metastasis in the head and neck (HN) region without known primary tumours (PTs). Statistical values of 3T-MRI and of FDG-PET/CT scans were evaluated. RESULTS: Of the 38 CUPs, conventional native T1-, T2-weighted and STIR sequences detected 6 PTs. Native sequences plus diffusion-weighted imaging (DWI) found 14-, and with fat suppression contrast-enhanced T1-weighted measurement as well as with the complex MPMRI found 15 primaries and with PET/CT 17 CUPs could be evaluated, respectively. The detection rates were 15.8, 36.8, 39.5, 39.5 and 44.7 % for conventional native MRI, native plus DWI, native with contrast-enhanced MRI (CE-MRI), for MPMRI, and for PET/CT, respectively. The overall detection rate proved by histology was 47.4 %. PET/CT provided the highest sensitivity (Sv: 94.4 %) but a lower specificity (Sp: 65.0 %), using MPMRI (Sv: 88.2 %) the specificity increased to 71.4 %. DWIincreased specificity of the native sequences (Sp: 76.2 %). Conventional native sequences plus DWI as well as 3T-MPMRI and PET/CT were same accurate (Acc: 79.0 %) and had similar likelihood ratio (LR: 3.42, 3.03 and 2.62) in detecting unknown PT sites. CONCLUSIONS: The accuracy of FDG-PET/CT and MPMRI in case of CUP in finding the primary cancer in the neck regions is identical. While using PET/CT whole body information can be obtained in one examination. MPMRI shows the local soft tissue status more accurately. In cases of CUP PET/CT should be the first method of choice if it is available. MPMRI can clarify the exact primary tumor stage, and it can be advantageous in clarifying the prognostic factors, which is necessary in case of advanced tumor stage and when surgery is under consideration. In case low N stage is likely after the clinical examination and wait and see policy can be considered, MPMRI is recommended, and in this case the significance the of radiation free MPMRI is increasing.

Dynamic Contrast-Enhanced MRI Parameters as Biomarkers in Assessing Head and Neck Lesions After Chemoradiotherapy Using a Wide-Bore 3 Tesla Scanner.

Pilot studies have shown promising results in characterizing head and neck tumors (HNT) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), differentiating between malignant and benign lesions and evaluating changes in response to chemoradiotherapy (CRT). Our aim was to find DCE-MRI parameters, biomarkers in evaluating the post-CRT status. Two hundred and five patients with head and neck lesions were examined with DCE-MRI sequences. The time intensity curves (TIC) were extracted and processed to acquire time-to-peak (TTP), relative maximum enhancement (RME), relative wash-out (RWO), and two new parameters attack and decay. These parameters were analyzed using univariate tests in SPSS (Statistical Package for the Social Sciences, version 17, SPSS Inc. Chicago, USA) to identify parameters that could be used to infer tumor malignancy and post-CRT changes. Multiple parameters of curve characteristics were significantly different between malignant tumors after CRT (MACRT) and changes caused by CRT. The best-performing biomarkers were the attack and the decay. We also found multiple significant (p < 0.05) parameters for both the benign and malignant status as well as pre- and post-CRT status. Our large cohort of data supports the increasing role of DCE-MRI in HNT differentiation, particularly for the assessment of post-CRT status along with accurate morphological imaging.

[New opportunities, MRI biomarkers in the evaluation of head and neck cancer]. / Új lehetoségek, MRI-biomarkerek a fej-nyaki daganatok értékelésében.

Magnetic resonance imaging (MRI) has developed rapidly during the past few years and, according to the needs of therapy, has opened new perspectives in oncologic imaging with better and better realization of the latest technological advances. After the introduction of "organ preservation" protocols the role of imaging has become more important. New therapeutic methods (improvement in radiation therapy and chemotherapy) need better tumor characterization and prognostic information along with the most accurate anatomical information. Multiparametric anatomical and functional MR imaging (MM-MRI) using high magnetic field strength (3 Tesla) are useful in determining tumor-specific MRI biomarkers and in evaluating the changes in these parameters during therapy to provide early assessment of the therapeutic response. Diffusion-weighted MRI (DW-MRI) provides information at the cellular level about cell density and the integrity of the plasma membrane. DW-MRI shows potential in improving the detection of cancer due to its high specificity and high negative predictive value. Quantification is performed using an apparent diffusion coefficient (ADC), the values are independent of the magnetic field strength. In the latest publications the accuracy of DW-MRI has been reported around 90% for the differentiation between malignant versus benign tumor using an ADC cut-off mean value of 0.700-1.200 10(-3) mm(2)/s units, but no common threshold ADC value exists in clinical routine for the differentiation of malignant and benign tissues. Dynamic contrast-enhanced MRI (DCE-MRI), as a marker of angiogenesis, provides information about vascularization at the tissue level. Angiogenetic alterations cause changes in the parameters of vascular physiology (perfusion, blood volume, capillary permeability) and thus alter the contrast enhancement observed on contrast MRI. High-grade and/or advanced stage tumors are associated with increased blood volume, increased permeability and increased perfusion; the data can be evaluated using semiquantitative or quantitative methods. Magnetic resonance spectroscopic imaging (MRSI) provides biochemical analysis at the molecular level. The results are promising, although further studies are required to determine whether MRSI can be used to identify or exclude cancer within regions where the cancer is not evident on conventional MRI or with the other functional imaging methods. Some of the studies demonstrated the usefulness of these functional MRI methods also in the head and neck region to differentiate benign from malignant tumors, to quantify the response to radiation therapy and chemotherapy, to identify residual or recurrent tumor and to correlate the perfusion or diffusion data with prognosis. There are still some overlaps between benign and malignant changes, and the use of these functional MR measurements in routine diagnostics are still not fully validated today. Functional MR measurements are useful parts of the high quality multiparametric MRI, they offer important supportive biological and molecular information with the aid of high resolution morphological imaging.

Aneurysmal bone cyst of the zygomatic arch: a case report.

We describe a case of an aneurysmal bone cyst originating from the zygomatic arch, which, according to the literature, is an extremely rare location. In the preoperative diagnosis the characteristic radiological signs of the high-quality computed tomography and magnetic resonance examinations were the cornerstones. Treatment was successful total excision. Careful diagnostic workup and multidisciplinary approach (head and neck surgeon, radiologist, and pathologist) should be utilized to successfully diagnose and to treat this rare pathology.

Transfemoral endovascular treatment of proximal common carotid artery lesions: a single-center experience on 153 lesions.

PURPOSE: To assess primary success and safety of percutaneous transluminal angioplasty (PTA) and/or stenting of ostial/proximal common carotid artery lesions (pCCA) and to compare its 30-day stroke/mortality level with the literature data for surgical options. METHODS: A total of 147 patients (153 stenoses, 6 recurrent) (71 female; 121 left) with significant diameter stenosis (>70% in symptomatic, n = 46; >85% in asymptomatic, n = 101 patients) of pCCA treated between 1994 and 2006 were retrospectively reviewed. With the exception of one, all procedures were performed using a transfemoral approach. A stent was implanted in 108 (70.5%) of cases. Stents were not available in the early years of our experience, but gradually became a routine practice. Embolic protection devices were used in 16 cases. Follow-up included neurological examination, carotid duplex scan, and office/telephone interview. RESULTS: Primary technical success was 98.7% (151/153 stenoses). There were no deaths. Periprocedural (<48 hours) neurological complications included 3/153 (2.0%) ipsilateral major strokes and 4/153 (2.6%) TIAs (including one contralateral TIA). There were 8/153 (5.2%) access site hematomas, 1/153 (0.7%) bradycardia, and 1/153 (0.7%) acute left ventricular failure with respiratory distress. Follow-up was achieved in 115/147 patients (78.2%) undergoing 120 procedures for a mean of 24.7 months and revealed one additional contralateral TIA and one additional minor stroke in an asymptomatic patient. In patients with follow-up, the 30-day procedural death/all-stroke rate was 3/120 (2.5%) The cumulative primary patency rate in the 115 patients with follow-up was 97.9% +/- 2.1% at 1 year, 82.0% +/- 7.1% at 4-years, and 73.5% +/- 12.7% at 7 years. The cumulative secondary patency rate was 100% at 1 year, 88.0% +/- 7.0% at 4 years, and 88.0% +/- 11% at 7 years. Log-rank test showed no statistical difference (P = .82) in primary cumulative patency between PTA alone (n = 34) or PTA/stent (n = 86). CONCLUSION: Transfemoral PTA/stenting appears to be appropriate treatment option for ostial/proximal common carotid artery significant stenoses. This study should also draw attention to the lack of data on natural history or effect of best medical treatment alone for these lesions, making evidence-based decision currently impossible for treatment of symptomatic or asymptomatic ostial and proximal common carotid artery significant stenoses.