Tumor Board

2006-194 95-09-18

Name :Chart No.Age : 50 Sex : M

Diagnosis:

1. Tongue cancer ,SCC

2. Buccal cancer , SCC (T1)

3. Palatal cancer , SCC (T1)

With right neck metastasis

P.H. / Alcohol (+) 1 cup高梁per day for 20 years
Betel nut (+) 10-20# per day for 10 years , quit for 7 years
Cigarette (+) 1 PPD for 20 years
Initial presentation : tongue mass for 6 months
88-04-07 / Wide excision of tongue tumor + left supraomohyoid neck dissection
Pathology : (S9907004)
Tongue : SCC: 2.1X2.1 cm (T2)
LNs: (40/40) negative for malignancy
Margin : free
Left buccal ,palatal lesion, parotid mass for 2-3 months
95-06-01 / MRI : as presented
95-06-02 / Excison of left buccal tumor and palatal tumor + left parotid mass excision
Pathology : (S0614873)
Left buccal : SCC
Soft palate : SCC
Parotid : lymphoid hyperplasia
Margin : free , tumor 0.5 cm
Lymphovascular (-) , perineural (-)
95-08-09 / Right submandibular tumor , ask for op
95-08-19 / Excision of right neck mass
Pathology : (S0622988)
SCC, metastatic (1/2)
95-09-05 / PET : as presented

Local finding:

2006-194

Image

2006-06-01

MR without and with enhancement showed:
1. Mass lesion suspected in the left buccal region.
2. No definite intracranial extension was shown.
3.Multiple tiny lymphadenopathy were shown in the submental, right submandibular spaces, carotid spacesand posterior cervical space. A focal lesion shown in the left infra-parotid region.
Impression:

Buccal tumor with multiple possible reactive lymphadenopathy.R/O metastases in the left infraparotid region.

2006-06-05

Whole body FDG

No definite abnormal hypermetabolic lesion noted

Discussion

ASP婁 : 這是一個triple cancer 的case, 這次的primary 都很小, 屬T1,也沒有什麼 risk factor ,所以建議定期追蹤, 沒有後續治療,但兩個月後就發現右邊submandibular mass跑出來,只有一顆node, 也曾懷疑是否由其他origin轉移, 但PET 都沒有, pathology 出來是metastatic SCC, 若是這樣, 則屬N2c. 想問一下是否要後續治療 ?

L 楊 : 定義上是N2C, 且又是Triple cancer,要電療比較好

Ap柯: Primary lesion 應該可以不用電療, 但Parotid 的node應該也要高度懷疑是轉移

P 徐 : 應該是上次的Neck dissection改變正常的lymphatic drainage, 所以才從左邊parotid 和 右邊 submandibular area跑出來. 如果病人很擔心的話 , 還是做後續治療(電療),建議做左邊parotid 和 右邊 submandibular area 電療