Atypical presentation of a piriform sinus tumor Disclosures No - PowerPoint PPT Presentation

ESMO Preceptorship Programme Head & Neck Cancer – Zurich – 22-23 May 2018 Sarah Deschuymer – MD Radiation oncologist in training Department of Radiation Oncology University Hospitals Leuven, Leuven, Belgium Atypical presentation of a piriform sinus tumor

Disclosures � No disclosures ESMO PRECEPTORSHIP PROGRAMME

Case report – Male, 58y – Presentation: painless swelling in upper left neck – No weight loss, no dysphagia, no odynophagia – No relevant medical history, no medication intake – Smoking: 1-2 packs of cigarettes a day, 60 PY – Alcohol: 6 units during the weekend � CLINICAL EXAMINATION: – enlarged, mobile node IIA left – no mucosal lesions in the mouth – no teeth ESMO PRECEPTORSHIP PROGRAMME

Investigations Ultrasound neck: vasculated node IIA left 3.5 x 2 x 2.2 cm; � FNAC: necrotic debris, atypical epithelial cells, metastatic node of – squamous cell carcinoma 2 1 FDG-PET-CT: hypercaptation of tracer in: 3 � 4 Left Node IIA (1) – Right edge of tongue or hard palate (2) – 5 Left base of tongue (3) – Right piriform sinus (4) – Multiple nodes in mediastinum and lung hili (5) – What is your next investigation? � Direct laryngoscopy under general anaesthesia: – No mucosal lesions at the palate, tongue, oropharynx. No palpable indurations. – Normal vocal cords. – Right piriform sinus: exophytic tumor of 2 cm: cT2 => Biopsy • Path: moderatly differentiated squamous cell carcinoma, p16- � EBUS-TBNA: lung nodes 2R,4R, 7 • Path: representative sample, no arguments for malignancy � Gastroscopy: • Reflux oesophagitis grade A ESMO PRECEPTORSHIP PROGRAMME

Patient was sent to the department of radiation oncology: => chemoradiotherapy: cT2N2c: right piriform sinus tumor with a positive node IIA left. Do you agree with this diagnosis? Do you need additional information / investigations? What about the palate and base of tongue? � DW-MRI: known left adenopathy + right piriform sinus tumor – Left base of tongue: Small hypercaptating zone + diffusion restriction: tumor – cannot be excluded Right hard palate: Hypercaptating zone of 37x14x21mm: suspicious for tumor – � New direct laryngoscopy with incision biopsy : Base of tongue: p16-, squamous cell carcinoma, moderately differentiated – Hard palate: benign salivary gland tissue – New Diagnosis: � 2 primary tumors + benign salivary gland tissue How would you treat this patient? Radiotherapy 70 Gy/2Gy Cisplatin 100mg/m² 3-weekly GTV: right piriform sinus; left base of – tongue; left node IIA ESMO PRECEPTORSHIP PROGRAMME CTV elective: R: II-IV; L: IB-V –

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