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PURPOSE: Head and neck emergencies in children are frequent cause of visits to the hospital. Imaging plays a critical role in the management of these patients. This review article aims to familiarize radiologists with the common clinical presentations encountered, imaging characteristics of nontraumatic pediatric head and neck emergencies, and improve their ability to recognize associated complications as well as be aware of common mimics. METHODS: We researched our database for commonly encountered nontraumatic head and neck emergencies in children. A literature search was done to compare and complete the list of conditions to be discussed in this review. RESULTS: The review was organized according to anatomical location of the emergent condition. Relevant anatomy has been discussed along with clinical presentation, imaging characteristics and complications. We have presented common mimics with each set of disorders. Key imaging characteristics have been delineated using radiology images. CONCLUSION: Familiarity with the known complications of head and neck emergencies allows the radiologist to actively search for such findings, encourage early institution of appropriate therapy, and improve outcomes.

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BACKGROUND: The mechanism of human papillomavirus (HPV)-induced tonsillar squamous cell carcinoma (TSCC) has not been clearly elucidated, and the number of authenticated HPV (+) TSCC cell lines is extremely limited. OBJECTIVES: To establish and characterize a de novo HPV (+) TSCC cell line derived from a Korean patient with TSCC. MATERIALS AND METHODS: We performed in vitro and in vivo experiments for evaluation of tumorigenicity of our TSCC cell line. In addition, we evaluated the stemness traits of this cell. Finally, we examined the physical status of our cell whether this belonged to the episomal, integrated, or mixed type. RESULTS: The novel tonsillar cancer cell line, designated as KUSCC-152, was identified as a de novo TSCC cell line positive for HPV-16. In addition, the KUSCC-152 cell line has cancer cell traits in vitro and can induce tumor formation and metastasis to the neck lymph nodes in heterotopic and orthotopic xenograft mice. Moreover, the KUSCC-152 cells exhibited a cancer stemness phenotype, including sphere-forming capacity and the expression of stemness markers. Finally, we suggested that KUSCC 152 may belong to an integrated HPV incorporation type. CONCLUSIONS AND SIGNIFICANCE: We successfully established and characterized a novel integrated-type HPV (+) TSCC cell line from an East Asian patient.

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Children diagnosed with severe tonsillar hypertrophy display discernible craniofacial features distinct from those with adenoid hypertrophy, prompting illuminating considerations regarding microbiota regulation in this non-inflammatory condition. The present study aimed to characterize the salivary microbial profile in children with tonsillar hypertrophy and explore the potential functionality therein. A total of 112 children, with a mean age of 7.79 ± 2.41 years, were enrolled and divided into the tonsillar hypertrophy (TH) group (n = 46, 8.4 ± 2.5 years old), adenoid hypertrophy (AH) group (n = 21, 7.6 ± 2.8 years old), adenotonsillar hypertrophy (ATH) group (n = 23, 7.2 ± 2.1 years old), and control group (n = 22, 8.6 ± 2.1 years old). Unstimulated saliva samples were collected, and microbial profiles were analyzed by 16S rRNA sequencing of V3-V4 regions. Diversity and composition of salivary microbiome and the correlation with parameters of overnight polysomnography and complete blood count were investigated. As a result, children with tonsillar hypertrophy had significantly higher α-diversity indices (P＜0.05). ß-diversity based on Bray-Curtis distance revealed that the salivary microbiome of the tonsillar hypertrophy group had a slight separation from the other three groups (P＜0.05). The linear discriminant analysis effect size (LEfSe) analysis indicated that Gemella was most closely related to tonsillar hypertrophy, and higher abundance of Gemella, Parvimonas, Dialister, and Lactobacillus may reflect an active state of immune regulation. Meanwhile, children with different degrees of tonsillar hypertrophy shared similar salivary microbiome diversity. This study demonstrated that the salivary microbiome in pediatric tonsillar hypertrophy patients had different signatures, highlighting that the site of upper airway obstruction primarily influences the salivary microbiome rather than hypertrophy severity.IMPORTANCETonsillar hypertrophy is the most frequent cause of upper airway obstruction and one of the primary risk factors for pediatric obstructive sleep apnea (OSA). Studies have discovered that children with isolated tonsillar hypertrophy exhibit different craniofacial morphology features compared with those with isolated adenoid hypertrophy or adenotonsillar hypertrophy. Furthermore, characteristic salivary microbiota from children with OSA compared with healthy children has been identified in our previous research. However, few studies provided insight into the relationship between the different sites of upper airway obstruction resulting from the enlargement of pharyngeal lymphoid tissue at different sites and the alterations in the microbiome. Here, to investigate the differences in the salivary microbiome of children with tonsillar hypertrophy and/or adenoid hypertrophy, we conducted a cross-sectional study and depicted the unique microbiome profile of pediatric tonsillar hypertrophy, which was mainly characterized by a significantly higher abundance of genera belonging to phyla Firmicutes and certain bacteria involving in the immune response in tonsillar hypertrophy, offering novel perspectives for future related research.

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BACKGROUND: Chiari malformation type I (CM-1) is a complex disorder in which tonsillar herniation through the foramen magnum manifests with a spectrum of clinical symptoms. This work analyzes morphometric and volumetric characteristics of CM-1 patients. METHODS: With Institutional Review Board (IRB) approval, we retrospectively reviewed a total of 72 adult CM-1 patients and 26 healthy adult volunteers who underwent volumetric magnetic resonance brain imaging. Clinical data was retrospectively extracted from the electronic medical record. We analyzed multi-dimensional morphometric and volumetric features within the posterior cranial fossa and correlated these features with syrinx formation and the decision to undergo surgical decompression. RESULTS: In our study, CM-1 patients had decreased cerebellar, brainstem and 4th ventricular volumes but larger tonsillar volume with increased total tonsillar length. CM-1 patients who underwent surgery had significantly more neural tissue within the cross-sectional area of cisterna magna. Logistic regression demonstrated that combining neural tissue at foramen magnum with cerebellar & 4th ventricular volumes led to great degree of correlation with syrinx formation (AUC 0.911). CONCLUSIONS: Our findings suggest that the amount of tissue at the foramen magnum correlates with CM-1 patients who underwent decompressive surgery, more so than tonsillar length. Additionally, the combination of neural tissue at foramen magnum, cerebellar & 4th ventricular volumes led to great degree of correlation with syrinx formation. Together, these findings suggest that a global compressive phenomenon within the posterior fossa leads to CM-1 symptomatology and syrinx formation.

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Rationale: This study aimed to report an uncommon site of origin of a rare head-and-neck cancer, namely malignant granular cell tumour. Patient Concerns: An 89-year-old female patient complained of persistent pharyngodynia and odynophagia for two months. Diagnosis: Upon clinical examination, the right palatine tonsil was larger and palpably firmer than the contralateral. An incisional biopsy of the lesion was performed under local anaesthesia revealing malignant granular cell tumour. A contrast-enhanced computed tomography (CECT) scan of the head and neck and an 18F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) scan confirmed the presence of a pathologic appearance of the right palatine tonsil without nodal or distant metastasis. Treatment: Following a multidisciplinary consultation and the patient's informed permission, a right tonsillectomy extended to the constrictor muscle fibres of the upper pharynx was performed. Outcomes: The tumour was staged as pT2 R0 cN0 M0, according to the AJCC 8th edition for soft-tissue tumours of the head and neck. Due to the early stage and the radicality of surgery, no further adjuvant treatments were provided. The patient is currently followed up with no evidence of disease one year post-operatively. Take-away Lessons: Granular cell tumours are rare mesenchymal tumours, firstly described by the pathologist Abrikossoff in 1926. This type of tumour constitutes approximately 0.5% of all soft-tissue tumours, and can affect any part of the body, with the head and neck being the most frequently involved site. The tonsil is an extremely rare localisation of this cancer. The differential diagnosis of unilateral tonsillar enlargement should also include this histological entity.

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PURPOSE: Patients with p16 positive tonsillar cancer (p16 + TC) have an excellent prognosis and long-life expectancy. Deintensification of therapy is a prevalent topic of discussion. Proton radiotherapy is one way to reduce radiation exposure and thus reduce acute and late toxicity. The aim is to evaluate treatment outcomes and toxicity of postoperative treatment with intensity-modulated proton therapy (IMPT). METHODS: Between September 2013 and November 2021, 47 patients with p16 + TC were treated postoperatively with IMPT. Median age was 54.9 (38.2-74.9) years, 31 were males and 16 were females. All patients had squamous cell carcinoma and underwent surgery as a primary treatment. Median dose of radiotherapy was 66 GyE in 33 fractions. Bilateral neck irradiation was used in 39 patients and unilateral in 8. Concomitant chemotherapy was applied in 24 patients. RESULTS: Median follow-up time was 4.2 (0.15-9.64) years. Five-year overall survival, relapse free survival and local control were 95.7%, 97.8% and 100%. The most common acute toxicities were dermatitis and mucositis, with grade 2 + in 61.7% and 70.2% of patients. No acute percutaneous gastrostomy insertion was necessary and intravenous rehydration was used in 12.8% of patients. The most common late toxicity was grade 1 xerostomia in 70.2% of patients and grade 2 in 10.6% of patients. Subcutaneous fibrosis of grades 2 and 3 occurred in 17.0% and 2.1% of patients, respectively. One patient developed late severe dysphagia and became PEG-dependent. CONCLUSION: IMPT for the postoperative treatment of p16 + TC is feasible with excellent efficiency and acceptable acute and late toxicity.

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To assess the exact role of high-risk HPV testing in patients of carcinoma unknown primary with secondary metastasis to the neck who underwent TORS and neck dissection for identification of the primary site. A prospective study was carried out at a tertiary care centre over one year. Patients with unilateral neck swelling, which was cytologically proven squamous cell carcinoma neck metastasis, were included in the study. After clinicopathological evaluation, they underwent TORS-assisted ipsilateral radical tonsillectomy, tongue base mucosal wedge biopsy for primary site identification, and ipsilateral neck dissection. They underwent HPV RNA ISH from the tonsil, the base of the tongue and blood. They also underwent HPV DNA testing from the blood. P16 was done in the base of tongue, tonsil, and lymph node specimens. In the study cohort of 18 patients who underwent ipsilateral radical tonsillectomy, mucosal tongue base wedge biopsy and neck dissection, p16 positivity was isolated in 5.56%, 0% and 2.78% of patients, respectively. (n = 1/18, 0/18, 5/18). Interestingly, HPV E7 mRNA expression was absent in the tonsil /base of tongue specimens, but metastatic lymph nodes displayed expression in 11.11%. HPV DNA was undetected in all analysed tissues and patients' blood. In the Indian subcontinent, it is not essential to do detailed high-risk HPV analysis in cases of carcinoma unknown primary with secondary metastasis to the neck.

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Meta-analysis and systematic review. To understand the role of endoscopic third ventriculostomy (ETV) for the treatment of concurrent Chiari Malformation Type I (CMI) and hydrocephalus in adults. A literature search on PubMed and Medline with MeSH terms relating to ETV and CMI identified 155 articles between 1988 and 2024. After excluding pediatric cases and other CNS pathologies with associated CMI, 11 articles met inclusion criteria. The Newcastle-Ottawa Scale was identified to assess heterogeneity and risk of bias among the 11 studies analyzed in this systematic-review and meta-analyses compared pre- and post-operative outcomes to examine the use of ETV as a treatment modality for CMI with hydrocephalus. From the 11 included studies, 35 cases of concurrent CMI and hydrocephalus treated with ETV were identified. ETV provided a pooled rate of symptom resolution or improvement of 66%. Additionally, meta-analysis discovered the following pooled rates: a reduction of tonsillar descent in 94% of patients, decreased ventriculomegaly in 94%, and ETV patency in 99%. Syringomyelia, nausea, papilledema and cerebellar dysfunction did not have sufficient numbers for meaningful statistical analyses. However, in each of these categories, more than 85% of the symptoms or radiographic findings improved. This review summarizes the safety and efficacy of ETV for the concurrent management of acquired CMI with hydrocephalus. Specifically, ETV improves radiological outcomes of both ventriculomegaly and tonsillar descent as well as the most prevalent neurological symptom, headaches.

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Malformación de Arnold-Chiari , Hidrocefalia , Tercer Ventrículo , Ventriculostomía , Humanos , Malformación de Arnold-Chiari/cirugía , Malformación de Arnold-Chiari/complicaciones , Ventriculostomía/métodos , Tercer Ventrículo/cirugía , Hidrocefalia/cirugía , Neuroendoscopía/métodos , Resultado del Tratamiento

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INTRODUCTION: Extrapulmonary tuberculosis is rare even in endemic areas, and is dominated by lymph node involvement. Tonsillar tuberculosis is exceptional. The clinical examination and radiological explorations are non-specific. CASE PRESENTATION: A 45-year-old woman presented with chronic odynophagia and otalgia. Examination revealed an enlarged left palatine tonsil with an irregular surface and a firm consistency. Radiologic exploration was not specific. The patient underwent a tonsillar biopsy. Histopathology was consistent with tuberculosis and the patient was put on antitubercular drugs. CLINICAL DISCUSSION: Tuberculosis is a global public health problem. Extrapulmonary tuberculosis is rare and mainly affects lymph nodes. Tonsillar tuberculosis is frequentely seen in individuals with immunodeficiency. Clinical features and imaging findings are non-specific. Diagnosis is based on histopathological and microbiological findings to rule out differential diagnoses especially cancer. Treatment is based on anti-tuberculosis drugs. CONCLUSION: Our case illustrates a rare presentation of primary tuberculosis and highlights the importance of considering tuberculosis as a potential cause of tonsillitis.

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Tonsillar focal diseases (TFDs) are defined as "diseases caused by organic and/or functional damage in organs distant from tonsil, and the disease outcome is improved by tonsillectomy." Although several reports and reviews have shown the efficacy of tonsillectomy for TFDs, no guidelines for the clinical management of the diagnosis and treatment of TFDs have been reported. Therefore, the Society of Stomato-pharyngology established a committee to guide the clinical management of patients with TFDs, and the original guide was published in May 2023. This article summarizes the English version of the manuscript. We hope that the concept of TFDs will spread worldwide, and that one as many patients with TFDs will benefit from tonsillectomy.

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Tonsila Palatina , Tonsilectomía , Humanos , Tonsila Palatina/patología , Enfermedades Faríngeas/terapia

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BACKGROUND: Despite the better prognosis associated with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), some patients experience relapse and succumb to the disease; thus, there is a need for biomarkers identifying these patients for intensified treatment. Leucine-rich repeats and immunoglobulin-like domain (LRIG) protein 1 is a negative regulator of receptor tyrosine kinase signaling and a positive prognostic factor in OPSCC. Studies indicate that LRIG1 interacts with the LIM domain 7 protein (LMO7), a stabilizer of adherence junctions. Its role in OPSCC has not been studied before. METHODS: A total of 145 patients diagnosed with OPSCC were enrolled. Immunohistochemical LMO7 expression and staining intensity were evaluated in the tumors and correlated with known clinical and pathological prognostic factors, such as HPV status and LRIG1, CD44, Ki67, and p53 expression. RESULTS: Our results show that high LMO7 expression is associated with significantly longer overall survival (OS) (p = 0.044). LMO7 was a positive prognostic factor for OS in univariate analysis (HR 0.515, 95% CI: 0.267-0.994, p = 0.048) but not in multivariate analysis. The LMO7 expression correlated with LRIG1 expression (p = 0.048), consistent with previous findings. Interestingly, strong LRIG1 staining intensity was an independent negative prognostic factor in the HPV-driven group of tumors (HR 2.847, 95% Cl: 1.036-7.825, p = 0.043). CONCLUSIONS: We show for the first time that high LMO7 expression is a positive prognostic factor in OPSCC, and we propose that LMO7 should be further explored as a biomarker. In contrast to previous reports, LRIG1 expression was shown to be an independent negative prognostic factor in HPV-driven OPSCC.

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Biomarcadores de Tumor , Carcinoma de Células Escamosas , Proteínas con Dominio LIM , Neoplasias Orofaríngeas , Humanos , Neoplasias Orofaríngeas/virología , Neoplasias Orofaríngeas/metabolismo , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Pronóstico , Proteínas con Dominio LIM/metabolismo , Biomarcadores de Tumor/metabolismo , Biomarcadores de Tumor/análisis , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/virología , Anciano , Factores de Transcripción/metabolismo , Glicoproteínas de Membrana/metabolismo , Adulto , Antígeno Ki-67/metabolismo , Receptores de Hialuranos/metabolismo , Receptores de Hialuranos/análisis , Proteína p53 Supresora de Tumor/metabolismo , Infecciones por Papillomavirus/complicaciones , Inmunohistoquímica , Anciano de 80 o más Años , Tasa de Supervivencia

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OBJECTIVE: This study aimed to identify clinical and surgical features associated with poor long-term postoperative outcomes in patients diagnosed with Type I Chiari Malformation (CMI) treated with posterior fossa decompression with duroplasty (PFDD), with or without tonsillar coagulation. METHODS: This retrospective, single-center study included 107 adult patients with CMI surgically treated between 2010 and 2021. The surgical technique involved a midline suboccipital craniectomy, C1 laminectomy, durotomy, arachnoid dissection, duroplasty, and tonsillar coagulation until 2014, after which tonsillar coagulation was discontinued. Postoperative outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS) at a median follow-up of 35 months. Clinical, surgical, and neuroimaging data were analyzed using the Wilcoxon signed-rank test, Cox regression analysis, and Kaplan-Meier survival curves to identify predictors of poor functional outcomes. RESULTS: Of the 107 patients (mean age 43.9 years, SD 13), 81 (75.5 %) showed functional improvement, 25 (23.4 %) remained unchanged, and 1 (0.9 %) experienced worsened outcomes. Cephalalgia, bilateral motor weakness, and bilateral paresthesia were the most frequent initial symptoms. Tonsillar coagulation was performed in 31 cases (28.9 %) but was clinically associated with higher rates of unfavorable outcomes. The Wilcoxon signed-rank test indicated that long-term follow-up CCOS was significantly higher than postoperative CCOS (Z = -7.678, p < 0.000). Multivariate Cox analysis identified preoperative bilateral motor weakness (HR 6.1, 95 % CI 1.9-18.9; p = 0.002), hydrocephalus (HR 3.01, 95 % CI 1.3-6.9; p = 0.008), and unilateral motor weakness (HR 2.99, 95 % CI 1.1-8.2; p = 0.033) as significant predictors of poor outcomes on a long-term follow-up. CONCLUSION: This study highlights the high rate of functional improvement in CMI patients following PFDD. Preoperative motor weakness and hydrocephalus were significant predictors of poor long-term outcomes. Tonsillar coagulation did not demonstrate a clear clinical benefit and may be associated with worse outcomes. Our findings suggest that careful preoperative assessment and selection of surgical techniques are crucial for optimizing patient outcomes.

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Malformación de Arnold-Chiari , Humanos , Femenino , Masculino , Malformación de Arnold-Chiari/cirugía , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Descompresión Quirúrgica/métodos , Adulto Joven

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BACKGROUND: France has the sixth highest incidence of oropharyngeal cancer (OPC) in Europe, but the epidemiological impact of high-risk HPV (HR-HPV) remains poorly documented. The objective of our study was to assess the proportion of OPCs caused by HR-HPV in Paris, and its suburbs, over the four past decades. This area accounts for almost one-fifth of the total population of France. METHODS: OPCs diagnosed in 1981, 1986, 1991, 1996, 2001, 2006, 2011, 2016 and 2020/2021 in two of the main referral cancer centers for HNCs in Paris and its suburbs were retrieved from the tumor biobanks. HPV status was determined by p16-staining and HPV-DNA detection. Samples were considered HPV-driven if both assays were positive. Results were compared to the French cancer registry data. RESULTS: Samples from 697 OPC patients were assessed (including 82 % of all samples diagnosed in 2001, 2006, 2011, 2016, 2021). The proportion of HPV-driven cases rose from 2.7 % to 53 % between 1981 and 2021. HPV16 was the dominant genotype during the study period. Of patients with HPV-driven OPC, 81 % were male and 42 % were smokers versus 80 % and 92 % in their HPV-negative counterparts. The age of OPC patients increased significantly, during the study period, independent of their HPV status CONCLUSION: The proportion of HPV-driven OPCs has significantly increased in Paris and its suburbs, during the last four decades. OPCs has become the 2nd predominant type of head and neck cancer, in France. This may be linked to the rise in HPV-driven cases and the decrease of tobacco and alcohol consumption in men.

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Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Humanos , Neoplasias Orofaríngeas/virología , Neoplasias Orofaríngeas/epidemiología , Masculino , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Infecciones por Papillomavirus/complicaciones , Femenino , Persona de Mediana Edad , Paris/epidemiología , Anciano , Incidencia , Adulto

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The aim of this prospective pilot study was to compare culture and microbiome results of the removed tonsils of patients with assumed distant focal disease (11 patients) and those who underwent a tonsillectomy, due to other reasons, such as recurrent tonsillitis, tonsil stones or snoring (nine patients). Aerobic culture was carried out for samples taken from the surface of the tonsils by swabs before tonsillectomy for all 20 patients. The squeezed detritus and the tissue samples of removed tonsils, taken separately for the right and left tonsils, were incubated aerobically and anaerobically. The microbiome composition of tissue samples of removed tonsils was also evaluated. Based on the culture results of the deep samples Staphylococcus aureus was the dominating pathogen, besides a great variety of anaerobic and facultative anaerobic bacteria present in the oral microbiota in those patients who underwent tonsillectomy due to distant focal diseases. Microbiome study of the core tissue samples showed a great diversity on genus and species level among patients of the two groups however, S. aureus and Prevotella nigrescens were present in higher proportion in those, whose tonsils were removed due to distant focal diseases. Our results may support previous findings about the possible triggering role of S. aureus and P. nigrescens leading to distant focal diseases. Samples taken by squeezing the tonsils could give more information about the possible pathogenic/triggering bacteria than the surface samples cultured only aerobically.

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Microbiota , Tonsila Palatina , Tonsilectomía , Tonsilitis , Humanos , Proyectos Piloto , Tonsila Palatina/microbiología , Estudios Prospectivos , Masculino , Femenino , Adulto , Tonsilitis/microbiología , Tonsilitis/cirugía , Niño , Adolescente , Adulto Joven , Bacterias/aislamiento & purificación , Bacterias/clasificación , Bacterias/genética , Staphylococcus aureus/aislamiento & purificación , Persona de Mediana Edad

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This case report describes a distinctive presentation of invasive metastatic tonsillar head and neck squamous cell carcinoma (HNSCC) that recurred in a 34-year-old African American inmate, defying the expectations of conventional risk factors. This case underscores the significance of nuanced care in atypical HNSCC scenarios. The patient presented in October 2021 with bilateral lymphadenopathy and dysphagia, which led to the diagnosis of tonsillar squamous cell carcinoma. The patient's treatment trajectory included radiation therapy with concurrent cisplatin, a subsequent radical right neck dissection, and immunotherapy. Complications, including abscess formation, neutropenic fever, and anemia, necessitated a multidisciplinary approach and admission to Reception and Medical Center Hospital. Cultures revealed a distinct neck mass that cultured positively for a variety of bacteria. The patient's condition was significantly improved by strategic interventions and meticulous daily wound care. This case prompts exploration into unknown factors contributing to HNSCC development in a seemingly low-risk individual, challenging conventional risk profiles. Treatment challenges, including radiation, surgery, and immunotherapy, underscore the need for a multifaceted approach. The central role of intense wound care in mitigating complications and improving the patient's quality of life is pivotal. The patient's tumor and infection highlight the urgency of improving prison sanitation. Enhanced hygiene and health screenings could have lessened the severity of the patient's condition, underscoring the need for comprehensive health measures in correctional facilities. Moreover, specialized wound care has the potential to improve outcomes and reduce health risks within incarcerated populations.

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OBJECTIVES: The aim of this review is to focus on the possibility of patients with squamous cell carcinoma to develop a second primary disease such as DLBCL, perhaps because of the irradiation of the head and neck area. MATERIALS AND METHODS: A case of an 89-year-old man is reported, who initially underwent surgical and complementary treatment for neck squamous cell carcinoma of occult primary and later for tonsillar diffuse large B-cell non-Hodgkin lymphoma. RESULTS: The second primary was considered a recurrence in the neck of the original cancer of unknown primary, so a new surgical management was decided. The final pathology report described a diffuse large B-cell non-Hodgkin lymphoma. CONCLUSIONS: The importance of maintaining follow-ups for patients with occult primary cancers who are at an elevated risk of developing a metastasis or a second primary carcinoma outbreak is highlighted.

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Infectious mononucleosis (IM) is a clinical disease caused by the Epstein-Barr virus (EBV). Common presenting symptoms include sore throat, lymph node enlargement, fever, and malaise. Although severe upper airway obstruction is uncommon, it is a potentially fatal complication that requires immediate intervention. We describe the case of an 18-year-old Hispanic man who presented with a progressive sore throat and difficulty speaking, requiring endotracheal intubation for airway protection. CT images showed diffuse swelling of Waldeyer's tonsillar ring, multiple enlarged lymphadenopathies, and splenomegaly. Acute EBV infection was confirmed considering clinical presentation and using the heterophile antibody, anti-nuclear and anti-viral capsid antigens, and quantitative PCR. The patient was managed with ventilatory support, empirical antibiotic therapy, and systemic corticosteroids, achieving a positive outcome. Our case illustrates the use of corticosteroids in managing severe upper airway obstruction complicating IM.

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A 63-year-old male with stage IV hepatocellular carcinoma (HCC), accompanied by lung and adrenal metastases, presented with oral bleeding. Physical examination disclosed bleeding from the tonsillar mass. A head and neck computed tomography identified a 2.4 cm enhancing lesion in the right anterior ethmoidal sinus, extending to the nasal region and medial orbit. Tonsillar mass biopsy confirmed HCC metastasis, immunopositive for Hepatocyte Paraffin 1 (HepPar1) and Arginase. He was treated with local radiotherapy (30 fractions). The unique presentation of severe bleeding from a tonsillar biopsy-proven HCC metastatic lesion underscores the rarity of head and neck involvement. Extrahepatic metastasis, particularly to the head and neck area likely due to hematogenous spread, may be a major independent predictor of poor outcomes in HCC patients. Local radiotherapy to achieve local hemostasis and reduce tumor bulk should be considered. In patients with known HCC having new oropharyngeal symptoms, HCC metastasis should be considered for a timely diagnosis. Despite its rarity, this manifestation signifies an unfavorable prognosis, reinforcing the imperative for a multidisciplinary approach to enhance therapeutic outcomes in these complex scenarios.