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

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Atypical presentation of a piriform sinus tumor

Sarah Deschuymer – MD Radiation oncologist in training Department of Radiation Oncology University Hospitals Leuven, Leuven, Belgium

Head & Neck Cancer – Zurich – 22-23 May 2018

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Disclosures

No disclosures

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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

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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

• FDG-PET-CT: hypercaptation of tracer in:

– Left Node IIA (1) – Right edge of tongue or hard palate (2) – Left base of tongue (3) – Right piriform sinus (4) – Multiple nodes in mediastinum and lung hili (5)

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-

1 4 3 2 5

What is your next investigation?

EBUS-TBNA: lung nodes 2R,4R, 7

• Path: representative sample, no arguments for malignancy

Gastroscopy:

• Reflux oesophagitis grade A

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Patient was sent to the department of radiation oncology: => chemoradiotherapy: cT2N2c: right piriform sinus tumor with a positive node IIA left.

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 Diagnosis:

2 primary tumors + benign salivary gland tissue

Do you agree with this diagnosis? Do you need additional information / investigations? What about the palate and base of tongue?

New direct laryngoscopy with incision biopsy:

– Base of tongue: p16-, squamous cell carcinoma, moderately differentiated – Hard palate: 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 – CTV elective: R: II-IV; L: IB-V

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Thank you for your attention