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INTRODUCTION: Sclerosing epithelioid fibrosarcoma (SEF) is an extremely rare form of bone and soft tissue sarcoma. It occurs mainly in the deep soft tissue of the lower extremities, with few cases reported in the head and neck region. Tumors involving the oral and maxillofacial region (OMFR) and intraosseous examples are rare. CASE PRESENTATION: We present a 52-year-old male with a radiolucent lesion at the apex of the left mandibular second molar tooth with the clinical impression of a periapical granuloma. The patient has a history of SEF of the skull, which was treated by chemotherapy and radiation. Histopathologic examination revealed islands of highly cellular, basophilic bone and osteoid surrounded by loose fibrous stroma, which contains large lobules and islands of round to oval cells with distinct cell borders and faintly granular eosinophilic cytoplasm. Tumor cells were strongly positive for MUC4 and INI-1. Based on these findings, a diagnosis of high-grade malignancy consistent with SEF was made, and correlation with the primary lesion was recommended. CONCLUSION: SEF is a rare tumor seen in OMFR, and therefore, it should be included in the differential diagnosis of any high-grade malignancy. Immunohistochemical stain for MUC-4 evaluation is important for the diagnosis of SEF.
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BACKGROUND: A tuberculosis infection of the central nervous system can present as a localized, intraspinal tuberculoma. These lesions may cause spinal cord compression requiring early identification and surgical decompression to limit deleterious neurological sequelae. OBSERVATIONS: A 28-year-old female with a history of opioid use disorder presented with low-back pain in the setting of trauma with progressive bilateral lower extremity radiculopathy and paraparesis. T1- and T2-weighted magnetic resonance imaging sequences of the spine demonstrated a heterogeneously hyperintense extra-axial epidural mass at T11 with mass effect. Biopsy of the lesion revealed benign soft tissue with necrosis and caseating granulomatous inflammation consistent with tuberculoma. The patient underwent laminectomy and debulking of mass for decompression and was subsequently began antitubercular treatment with good neurological outcome. LESSONS: To the best of the authors' knowledge, there are only a handful of microbiologically and radiographically confirmed cases of spinal epidural tuberculoma in English literature. These lesions are rare and difficult to clinically and radiographically characterize in the absence of systemic pulmonary TB symptoms. Tuberculoma is an important differential for a spinal epidural mass, particularly because resection with systemic antitubercular treatment results in symptom resolution.
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OBJECTIVES: Standard treatment for patients with poor-risk, resected head and neck squamous cell carcinoma (HNSCC) is adjuvant radiation therapy combined with high-dose cisplatin. Many patients are treated with weekly cisplatin; it is not known whether weekly and high-dose cisplatin are equivalent. This study compares the outcomes of patients with locally-advanced HPV-negative HNSCC and HPV/p16-positive oropharynx HNSCC treated with adjuvant chemoradiation therapy with either high-dose or weekly cisplatin. MATERIALS AND METHODS: Retrospective review of patients with Stage III/IV HNSCC who had surgery followed by adjuvant chemoradiation therapy at Mayo Clinic, Rochester. HPV and/or p16 status was available for all oropharynx patients. RESULTS: 104 Patients (51 high-dose, 53 weekly) were analyzed. The 3-year overall survival was 84% and 75% for patients who received high dose and weekly cisplatin, respectively (p=0.30). The 3-year recurrence free survival was 71% and 74% in the high dose and weekly cisplatin group, respectively (p=0.95). Patients with HPV/p16-positive oropharynx cancer who received adjuvant chemoradiation therapy with high-dose and weekly cisplatin had three-year overall survival rates of 91% and 86% (p=0.56), and 3-year recurrence free survival of 84% and 82% (p=0.93). Extracapsular extension did not affect prognosis in either group. CONCLUSIONS: No significant survival difference was seen between patients with locally advanced HNSCC treated with adjuvant chemoradiation therapy with high-dose or weekly cisplatin, although there was a trend for improved survival with high-dose cisplatin. Weekly cisplatin in the adjuvant setting may be a better treatment for patients with HPV-positive oropharynx cancer to preserve survival and minimize toxicity.
