Tumor Board
2007 96-12-31
Name : Chart No. Age : 56 Sex : M
Diagnosis:
- Hypopharyngeal cancer, pT1N3M0, stage IV
Social Hx: A(-)B(+) social, quitted for 4~5 years C(+) social, quitted for 4~5 years
Initial:Right neck mass noted for 1 month
PH / DM(+), HTN(-), CAD(+), old CVA96-05 / Right neck mass noted for 1 month
XXXX hospital:
Buccal biopsy: negative, FNA: SCC
Image: not available
Abdominal echo and bone scan: pending
96-06-13
96-06-13
96-06-15
96-06-15
96-06-28
96-06-29
96-07-05
96-07-09
96-07-10
96-08-06~
96-10-02
96-11-20
96-12-25 / OPD at NTUH
Admission
LMS biopsy:
Pathology: Hypopharyngeal SCC
CXR: Normal heart size. mild upper mediastinal widening. No definite focal lung lesion and sharp bilateral CP angles.
Neck MRI with contrast: to be presented
Admission
Total laryngectomy + MRND, type I, right + SND, level II, III, IV, left + Excision of oral tumor
Abdominal echo: No malignancy found
Neck CT with contrast: to be presented
Whole body bone scan:No definite metastatic bony lesion noted
Admission for CCRT regimen
ONC OPD:
Right ptosis, diplopia for 1 week, right CN.6 palsy
ONC OPD
Neck MRI with contrast: to be presented
CXR: No active lung lesion
Biopsy suggested
Local findings:
2007-250
檢查日期：2007-06-13
MRI With/Without Contrast--Neck
(Right neck mass aspiration: SCC. Endoscopic examination at our OPD showed granular lesion at right hypopharynx)
MRI of neck without/with contrast enhancement shows
1. confluent LAPs in right neck level II and III. Some portion of the mass show necrosis. The long axis of the LAP is slightly larger than 6cm. N3 disease is considered.
2. focal abnormal mucosal thickening is found at right pyriform sinus, bettern shown on the coronal images. r/o hypopharyngeal cancer. suggest correlate with tissue proof.
3. no obvious abnormal mucosal thickening at nasopharynx and oropharynx.
4. no obvious mass lesion in the parotid, submandibular and thyroid glands.
5. no obvious abnormality at skull base and visible brain.
6. the paranasal sinuses are clear.
Impression
right neck metastatic LAPs (N3) and suspicious right hypopharyngeal cancer.
檢查日期：2007-12-25
MRI With/Without Contrast--Neck
History of hypopharyngeal cancer, pT1N3M0, s/p total laryngectomy + MRND, type I, right + SND, level II, III, IV, left + excision of oral tumors (left oral tongue, right upper gingiva and buccal), and CRRT finished on 2007-10-01.
Neck MRI with/without contrast enhancement shows:
1. post-op change of oral cavity, tongue, hypopharynx and right neck. s/p tracheostomy , s/p NG tube insertion.
2. post-RT mild edematous change in bil. neck interstitium.
3. a soft tissue mass (3.7cm in long axis) at right superior gingiva with heterogeneous enhancement and upward extension to hard palate and maxillary sinus, which is not present on the prior image on 2007-07-09. The possibility of gingival cancer should be excluded.
4. Abnormal enhancing soft tissue at right cavenous sinus, petrous apex, clivus. Skull base metastasis with intracranial tumor invasion is considered.
5. no obvious LAPs in bil. neck
6. chronic infarction at right temporo-parietal lobe with encephlomalacic change and adjacent ventricular dilatation.
7. paranasla sinusitis.
Impression
post-op and RT change. right upper gingival mass, probable malignancy. Right skull base and cavernous sinus metastasis.
Discussion:
AP 婁: 這片子怪, XX懷疑口腔癌轉移但是開刀非cancer, 所以hypopharyngeal cancer stage T1 而已, 但CCRT做完後 right upper gingiva 一個月大起來verrucous cancer, cavenous sinus 完全不相連的東西跑出, 這如何解釋?
AP 柯: Skull base LN, 口腔 gingiva 應是另外一回事
P 徐: Gingiva verrucous cancer 自己長, skull base 則可能是meta 來的, 做PET看看也許其他地方也有, Tissue prove ? 可行嗎?
AP 柯: N3 了, T1N3Mx 的case 了
Radiologist 王: hypopharynx R/T至skull base那麼高是OK的, gingiva, skull base R/T包括也可以
AP 婁: oral 沒症狀，operation沒問題，但是intracranial 那塊化療可行而已
P 徐: 要跟病人講清楚這病難治，為了生活品質才去做，電療則是別讓他壞下去