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OBJECTIVES: Because prostate-specific membrane antigen (PSMA) expression is universal in juvenile nasal angiofibroma (JNA), PSMA PET/CT is commonly used in the postoperative setting using the postoperative angiofibroma radionuclide imaging study protocol. Our study aims to illustrate physiological PSMA ligand uptake distribution characteristics in the salivary glands, specifically the tubarial glands with tumor, to aid in accurate PSMA PET/CT analysis. STUDY DESIGN: Forty-three consecutive patients who underwent a dedicated head and neck spot PSMA PET/CT for JNA were evaluated retrospectively. PSMA SUVmax values in the tumor, tubarial, parotid, submandibular, and sublingual salivary glands were determined visually and quantitatively. RESULTS: All the tumors and the salivary glands showed increased tracer uptake. The median SUVmax ± SD ratios of the tumor, right and left tubarial gland, right and left parotid gland, right and left submandibular gland, and right and left sublingual gland were 2.7 ± 0.8 (range, 0.5-7.5), 3.8 ± 1.9 (range, 0.9-8.1), 4.7 ± 2.1 (range, 0.8-7.4), 9.5 ± 4.8 (range, 3.2-21.9), 9.2 ± 4.7 (range, 2.9-18.9), 10.4 ± 5.7 (range, 3.5-25.4), 10.4 ± 5.5 (range, 3.7-26.4), 6 ± 4.1 (range, 1.3-20.6), and 6.5 ± 4.2 (range, 1.8-19.7), respectively. The uptake in the tubarial glands was comparable with that of the tumor but less compared with other major salivary glands. CONCLUSIONS: Ours is the first study demonstrating the quantitative uptake of tubarial salivary glands in detail. Because the tubarial glands uptake and the anatomical location are similar to that of the tumor, these physiological uptakes must be borne in mind to circumvent false-positive interpretations and care must be given during the planning of stereotactic radiotherapy for JNAs.
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Antígenos de Superficie/metabolismo , Glutamato Carboxipeptidasa II/metabolismo , Glándulas Salivales/metabolismo , Angiofibroma/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Transporte de Proteínas , Estudios Retrospectivos , Glándulas Salivales/diagnóstico por imagenRESUMEN
OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) expresses prostate-specific membrane antigen (PSMA), and PSMA PET/CT scan may be used for its imaging. Also, the precise diagnosis of residual/recurrent JNA after surgical treatment remains difficult with conventional contrast MRI and/or CT; functional imaging with PSMA PET/CT promises greater accuracy in the detection or exclusion of recurrent/residual JNA. PATIENTS AND METHODS: In this prospective study, 22 postoperative JNA patients who underwent a PSMA PET/CT scan both preoperatively and postoperatively from January 2018 to September 2020 were included. All patients underwent a low-dose head and neck spot PET/CT imaging. Abnormal postcontrast enhancement of a definite lesion was considered residual/recurrent tumor in contrast-enhanced MRI (CEMRI). In PSMA PET/CT, any abnormal uptake apart from physiological sites in the head and neck was considered as residual lesions. Radiological results were categorized as negative, suspicious for residual lesions, or definite residual/recurrent tumors. PSMA PET/CT findings were considered as the radiological standard, and patients were managed accordingly. The sensitivity, specificity, positive predictive value, and negative predictive value were separately calculated for CEMRI and PSMA PET/CT for diagnosing residual lesions. RESULTS: On postoperative CEMRI evaluation, 12 patients had residual tumors, 2 had normal suspicious scans, and 8 had normal postoperative scans. On PSMA PET/CT, only 7 patients had residual tumors and 15 had normal postoperative scans. In 1 patient with a residual tumor on both scans, a discrepancy was noted concerning tumor extent, and PSMA PET/CT accurately mapped the tumor. The sensitivity, specificity, positive predictive value, and negative predictive value of CEMRI were 100%, 53.33%, 41.67%, and 100%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of PSMA PET/CT were 100% for all parameters. CONCLUSIONS: Because CEMRI is oversensitive and less specific compared with PSMA PET/CT, Postoperative Angiofibroma Radionuclide Imaging Study (PARIS) protocol should be used always. In residual tumors, PSMA PET/CT has an outright advantage over CEMRI in the diagnosis, tumor mapping, decision making, planning stereotactic radiation, and aiding in future follow-ups.
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Angiofibroma/diagnóstico por imagen , Angiofibroma/metabolismo , Antígenos de Superficie/metabolismo , Glutamato Carboxipeptidasa II/metabolismo , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/metabolismo , Tomografía Computarizada por Tomografía de Emisión de Positrones , Anciano , Angiofibroma/patología , Angiofibroma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/cirugía , Periodo Posoperatorio , Prueba de Estudio Conceptual , Estudios ProspectivosRESUMEN
OBJECTIVES/HYPOTHESIS: Somatostatin receptors (SSTRs) are highly expressed in neuroendocrine tumors and is exploited for its imaging and treatment. SSTRs expression is also demonstrated in diverse benign and malignant tumor cell types and proliferating peri-tumoral vessels. Similarly, Juvenile Nasopharyngeal Angiofibroma (JNA) expresses different SSTRs and may be utilized for its imaging and treatment using DOTA, 1-Nal3-octreotide (DOTANOC)-PET/CT scan. STUDY DESIGN: Prospective cohort. METHODS: Nineteen clinico-radiologically diagnosed primary JNA patients underwent a 68 Ga-DOTANOC PET-CT scan. Using a dedicated PET/CT scanner, a low-dose head and neck spot CT scan was performed after 45 to 60 minutes of intravenous injection of 2 to 3 mCi(74-111 MBq) of DOTANOC. The primary objective was to assess the intensity and pattern of DOTANOC uptake in these patients. RESULTS: DOTANOC expression was noted in all cases (n = 19) of primary JNA (100%). The mean (SD) DOTANOC SUVmax ratio of tumor and background was 6.9+/-1.4(range, 3.8-9.5). Intra-cranial extension in all 13/19 patients was prominently visualized due to the absence of DOTANOC uptake in the brain. Compared to the background all stages of JNA showed significant DOTANOC uptake (P < .0001). No difference in uptake between advanced-stage tumors and early tumors was noted (P = .47). A statistically non-significant negative trend was noted for decreasing uptake with increasing age (Spearman correlation coefficient, r = -0.19). CONCLUSIONS: This first study of 68 Ga-DOTANOC-PET/CT scan in JNA demonstrates consistent and reliable uptake activity in all patients irrespective of age and stage. This opens up possibilities to physiological diagnostic imaging with a promise of greater specificity and sensitivity and may have applications in ambivalent diagnostic situations such as the detection of recurrence. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1509-1515, 2021.
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Angiofibroma/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Compuestos Organometálicos/administración & dosificación , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos/administración & dosificación , Adolescente , Angiofibroma/patología , Angiofibroma/terapia , Antineoplásicos Hormonales/administración & dosificación , Quimioterapia Adyuvante/métodos , Niño , Femenino , Flutamida/administración & dosificación , Humanos , Masculino , Imagen Molecular/métodos , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/terapia , Nasofaringe/diagnóstico por imagen , Nasofaringe/patología , Nasofaringe/cirugía , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias , Compuestos Organometálicos/farmacocinética , Proyectos Piloto , Estudios Prospectivos , Radiofármacos/farmacocinética , Receptores de Somatostatina/metabolismo , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Somatostatin (SST) cell surface receptors (SSTRs) are expressed in many different malignant, benign, and neuroendocrine tumors. SSTRs are also expressed in the endothelium of human vessels during angiogenesis and not in the nonproliferating vessels. We present a case of 19-year-old boy with juvenile nasal angiofibroma (JNA), who underwent 68Ga-DOTANOC PET/CT to explore SSTRs expression and theranostic potential. The scan revealed high uptake in the tumor, and in certain areas, the uptake was similar to that of the pituitary gland. Performance of DOTANOC PET/CT in JNA opens up new frontiers with respect to radiological staging, early recurrence identification, better delineation from postoperative scar tissue, possible preoperative treatment with SST analogs, and perhaps even radiopharmaceutical based-ligand therapy of inoperable/residual/recurrent JNAs in the future.
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Masseteric-facial anastomosis has gained popularity in recent days compared to the facial-hypoglossal anastomosis. Masseteric nerve has numerous advantages like its proximity to the facial nerve, stronger motor impulse, its reliability, low morbidity in harvesting and sacrificing the nerve and faster re-innervation that is achievable in most patients. The present case series demonstrate the surgical technique and the effectiveness of the masseteric nerve as donor for early facial reanimation. Between January 2017 and February 2019, 6 patients (2 male, 4 female) with iatrogenic unilateral complete facial paralysis (grade VI, House Brackmann scale) who underwent masseteric-facial nerve anastomosis were included in the study. The time interval between the onset of paralysis and surgery ranged from 4 to 18 months (mean 8.5 months). In all patients pre-operative electromyography had facial mimetic muscle fibrillation potentials. All patients underwent end to end anastomosis except for one patient where greater auricular interposition graft was used. In all cases, the facial muscles showed earliest sign of recovery at 2-5 months. These movements were first noticed on the cheek musculature when the patients activated their masseter muscle. Eye movements started appearing at 6-9 months (in 3 cases) and forehead movements at 18 months (in 1 case). According to the modified House-Brackmann grading scale, one patient had Grade I function, two patients had Grade II function, and three had Grade V function. There was no morbidity except one patient who underwent interposition graft had numbness in the ear lobule. None of the patients could feel the loss of masseteric nerve function. Masseteric facial nerve anastomosis is a versatile, powerful early facial dynamic reanimation tool with almost negligible morbidity compared to other neurotization procedures for patients with complete facial nerve paralysis.
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We present a case of a 16-year-old boy who underwent 68Ga-PSMA PET/CT for residual disease assessment of juvenile nasal angiofibroma. Positive uptake was noted in residual tumor on PET/CT imaging. However, there was no abnormal uptake in surrounding scar tissues as compared with contrast-enhanced magnetic resonance imaging. These findings were confirmed by biopsy from the scar tissue on posterior ethmoids. 68Ga-PSMA PET/CT may be a potentially valuable tool especially in distinguishing recurrences from surgical site reparative tissue and in planning and delivering stereotactic radiotherapy.
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Prostate-specific membrane antigen (PSMA) is expressed in the endothelial cells of tumor-associated neovasculature of various nonprostatic benign and malignant neoplasms including juvenile nasopharyngeal angiofibroma (JNA). Positive uptake on PET/CT imaging with Ga-labeled PSMA is noted in a patient with residual disease after initial surgery without any abnormal uptake in postoperative fibrosis, in contrast to contrast-enhanced MRI, which was confirmed by biopsy. Ga-PSMA PET/CT may be a useful tool clinically for identifying early biochemical recurrences and in specifically differentiating recurrences from surgical site reparative tissue.
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Angiofibroma/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adolescente , Isótopos de Galio , Radioisótopos de Galio , Humanos , Masculino , Glicoproteínas de Membrana , Compuestos Organometálicos , RadiofármacosRESUMEN
PURPOSE: Prostate-specific membrane antigen (PSMA) is highly expressed in prostate cancer cells and is exploited for imaging and treatment of patients with prostate cancer. Prostate-specific membrane antigen expression is also demonstrated in the tumor-associated neovasculature endothelium. Juvenile nasal angiofibroma (JNA), being a similar highly vascular tumor, may also demonstrate significant PSMA expression, which may be utilized for its imaging and treatment. METHODS: In this prospective study, 25 clinicoradiologically diagnosed primary JNA patients underwent PSMA PET/CT scan. The scan was performed after 45 to 60 minutes of intravenous injection of 2 to 3 mCi (74-111 MBq) of Ga-PSMA-HBED-CC on a dedicated PET/CT scanner. Low-dose CT scan was acquired from vertex to sternoclavicular joint (100 mA, 20 kVp, 3-mm slice thickness, 0.8 pitch). Images were reconstructed with iterative reconstruction technique (4 iterations, 24 subsets). The objective was to assess the intensity and pattern of PSMA uptake in primary JNA patients. RESULTS: All cases (n = 25) of primary JNA showed PSMA expression in the tumor (100%). The median PSMA SUVmax ratio of tumor to background was 4.57 (range, 2.08-7.27). Intracranial extension in 14 of 25 patients was prominently visualized because of absence of background uptake in the brain. Advanced stage tumors demonstrated greater uptake than early tumors (P = 0.011). A statistically nonsignificant trend was noted for decreasing uptake with increasing age after normalizing for stage (Spearman correlation coefficient r = -0.08). CONCLUSIONS: Assessment of PSMA expression in JNA by PSMA PET/CT opens up a new window of opportunity with respect to its radiological staging, vascularity assessment, and molecular characterization. A potential role in identification of the difficult residual-recurrent disease is anticipated and perhaps also in radioligand therapy for residual/recurrent JNA.Clinical Trials Registry of India (CTRI/2018/08/015479).
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Angiofibroma/diagnóstico por imagen , Antígenos de Superficie/metabolismo , Glutamato Carboxipeptidasa II/metabolismo , Neoplasias Nasales/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adolescente , Angiofibroma/metabolismo , Antígenos de Superficie/genética , Niño , Ácido Edético/análogos & derivados , Ácido Edético/farmacocinética , Isótopos de Galio , Radioisótopos de Galio , Glutamato Carboxipeptidasa II/genética , Humanos , Neoplasias Nasales/metabolismo , Oligopéptidos/farmacocinética , Radiofármacos/farmacocinética , Adulto JovenRESUMEN
Prostate-specific membrane antigen (PSMA) is expressed on the endothelial cells of tumor-associated neovasculature of various nonprostatic benign and malignant neoplasms. Positive uptake on PET/CT imaging with Ga-labeled PSMA is noted in a patient with juvenile nasal angiofibroma, and the same is noted to be absent following complete surgical excision. Ga-PSMA PET/CT may be a useful tool for juvenile nasal angiofibroma recurrence identification and in differentiating recurrence from surgical site reparative tissue.
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Angiofibroma/diagnóstico por imagen , Angiofibroma/cirugía , Glicoproteínas de Membrana , Neoplasias Nasales/diagnóstico por imagen , Neoplasias Nasales/cirugía , Compuestos Organometálicos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adolescente , Angiofibroma/patología , Isótopos de Galio , Radioisótopos de Galio , Humanos , Masculino , Neoplasias Nasales/patología , Periodo PosoperatorioRESUMEN
BACKGROUND: Head-and-neck paragangliomas (HNP's) are rare autonomic neoplasms associated with high morbidity and mortality. We aimed to study epidemiology, clinicopathological correlation, and management of HNP to assist clinicians in advocating the most appropriate therapy. MATERIALS AND METHODS: Epidemiological parameters, including age and sex distribution, clinical presentation, tumor classification, familial predisposition, multicentricity, and treatment modalities adopted, were analyzed in this retrospective analysis of 54 patients of HNP. RESULTS: Age ranged from 15 to 85 years, with a female preponderance. Among all HNP, carotid body tumor (CBT) (48.1%) was the most common, followed by Glomus Jugulare (24.1%). Majority of the patients presented with neck swelling associated with nerve palsies. A preoperative neurological deficit was most commonly observed with Glomus jugulotympanicum (68.4%). CONCLUSION: CBT is the largest and most common paraganglioma in our study. The familial occurrence warrants meticulous screening for multifocality. Tumor location, neurovascular involvement, malignant potential, and patient factors should guide the designing of management options.
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OBJECTIVE: Although till date no management protocol for esthesioneuroblastoma (ENB) has been standardized due to tumor rarity, still multimodality approach shows better treatment outcomes as compared to surgery alone. The objective of this study was to analyze the clinicopathological spectrum of ENB and to correlate treatment response with tumor staging, histopathological grading, and various treatment modalities. MATERIALS AND METHODS: Twenty-one consecutive patients with biopsy-proven ENB were studied and evaluated for response to treatment in the form of complete tumor resolution. Results were analyzed and correlated with stage and grade of tumor and form of therapy received. RESULTS: There was male preponderance (3.2:1) with age ranging between 7 and 63 years (median of 25 years). Survival rates significantly dropped with increasing tumor stage (63.6% in stages A and B vs. 30% in stages C and D) and grade (100% in Grades 1 and 2 vs. 31.25% in Grades 3 and 4). The recurrence rate was 80% in surgery alone group, which came down to 43.7% if surgery was supplemented with other modalities. In cases where multimodality treatment plan was used, endoscopic procedures fared equally as open surgical procedures. CONCLUSION: Hyam's grade and Kadish stage are important prognostic indicators of treatment outcome, with survival rates dropping with increasing tumor stage and grade. Multimodality treatment protocols have improved the disease outcome, making endoscopic surgery equivalent to radical surgeries regarding result outcomes and giving other advantages such as better cosmesis, less treatment-related morbidities, decreased hospital stay, and better cost-effectiveness.
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Schwannomas arising from cervical sympathetic chain are rare benign neoplasms which are slow growing, usually asymptomatic, biochemically non-secretory and functionally inactive tumours. We present a case of secretory schwannoma arising from the cervical sympathetic chain, causing hypertension and associated with raised urinary catecholamine degradation by-products. Transcervical excision of the tumour was followed by normalisation of blood pressure and urinary vanillylmandelic acid levels and pathologically the tumour was proved to be a schwannoma.
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Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/cirugía , Neurilemoma/diagnóstico por imagen , Neurilemoma/cirugía , Adolescente , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Cuello/diagnóstico por imagen , Cuello/cirugía , Intensificación de Imagen Radiográfica , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Temporal bone osteomyelitis is more commonly seen in immunocompromised patients and is very rare in non-immunocompromised individuals. Mucormycosis is a fulminating fungal infection caused by Mucor which is a saprophytic fungus commonly seen in diabetic patients. Here we report a case of temporal bone osteomyelitis in a child with a traumatic history which was causing clinical features of lateral sinus thrombosis. The patient was successfully treated and doing well post-operatively. CASE REPORT: An 11-year-old girl was reported to the emergency dept with fever and headache for 2 weeks. She had a fever of 100-102 °F without chills and rigors which was associated with severe headache on the right side and not associated with any vomiting, nausea, or aura. The patient did not have any other significant complaints except a history of falling 2 years previously when she was 9 years of age. The patient was admitted and a complete evaluation was performed clinically and radiologically. High-resolution computed tomography (HRCT) of the temporal bone was suggestive of soft tissue density at the sigmoid sinus of the right mastoid. The patient underwent surgery for debridement, and the tissue was sent for diagnosis. This revealed mucormycosis of the temporal bone and the patient started medical management. At the present date, the patient remains under follow up. CONCLUSION: Fungal chronic osteomyelitis is a disease among immune-compromised patients involving the temporal bone, and is very rare. In particular mucormycosis is very rare in the temporal bone but is not expected in normal individuals. HRCT of the temporal bone is the gold standard investigation, and tissue biopsy is diagnostic. Tissue debridement and long-time medical management with anti-fungal medication is mandatory to achieve good results.
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Anaplastic thyroid carcinoma (ATC), one of the most aggressive malignancies, is extremely rare in childhood. We present a case of 5-yearold child who presented with rapidly progressing thyroid swelling and stridor, for which she underwent emergency tracheostomy and biopsy. Histopathological features were suggestive of ATC and the patient died within two months after diagnosis. ATC, though very rare in childhood, should be kept in the differential diagnoses of rapidly enlarging neck masses in children. To the best of our knowledge, this is the youngest case of ATC reported in literature.
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Carcinoma Anaplásico de Tiroides/diagnóstico , Biopsia , Preescolar , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Carcinoma Anaplásico de Tiroides/patología , Carcinoma Anaplásico de Tiroides/cirugía , TraqueostomíaAsunto(s)
Paladar Blando/patología , Tonsila Palatina/patología , Sífilis/patología , Úvula/patología , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Pie/patología , Mano/patología , Humanos , Masculino , Neoplasias Orofaríngeas/diagnóstico , Papiloma/diagnóstico , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Adulto JovenRESUMEN
Temporal bone dissection has important role in educating, and training the surgeons. Temporal bone has complicated three dimensional anatomy and it is challenging for young surgeons to understand and operate. Not knowing the anatomy may cause serious consequences to patient due to injury to vital structures. It is important to learn temporal bone harvesting techniques, preservation of specimens, fixation and to reduce the health hazards posed by these specimens by taking safety measures. Spending more time in temporal bone laboratory and repeated dissection of temporal bones provides the skills necessary in the operating room for future generation. All training institutes should establish temporal bone laboratory in their department to provide the necessary expertise to future generation while maintaining safe and secure environment.
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Isolated metastatic deposits of papillary thyroid carcinoma to the parapharyngeal space are rare. Herein, we describe the case of a young woman who presented with a right-sided oropharyngeal mass that was initially diagnosed as a parapharyngeal space paraganglioma. The patient opted for conservative treatment as she was asymptomatic and wished to avoid the risk of neurovascular morbidity associated with surgery. After 20 years, the patient sought treatment again for the oropharyngeal mass, which had progressively increased in size and was causing difficulty in swallowing. Repeat imaging of the affected area revealed that the mass had increased significantly in size; it also revealed the presence of a previously absent small lesion in the right lobe of the thyroid. Excision of the parapharyngeal space tumour and near-total thyroidectomy were performed; the excised specimens showed features of the follicular variant of papillary thyroid carcinoma. As papillary thyroid carcinoma that metastasises to the parapharyngeal space can masquerade as a paraganglioma, clinicians should bear in mind that an isolated metastatic deposit in the parapharyngeal space could be the first sign of occult papillary thyroid carcinoma.