Facial Venous Tumour Thrombus from Submandibular Gland Mucoepidermoid Carcinoma: An Atypical Tumour Spread in Head and Neck Cancer.

Q3 Medicine
European journal of case reports in internal medicine Pub Date : 2024-08-21 eCollection Date: 2024-01-01 DOI:10.12890/2024_004762
Mariam Malik, Rana Bilal Idrees, Zeeshan Rashid Mirza, Sharifa Sikandar, Saba Nawaz, Maham Khalid, Muhammad Hamid Chaudhary
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引用次数: 0

Abstract

Background: Tumour thrombus of the facial vein is an exceedingly rare complication arising from mucoepidermoid carcinoma of the salivary glands. Early detection is pivotal for appropriate management, as delays can lead to metastatic disease, worsening the prognosis.

Case description: We present a case involving a 76-year-old male with a history of mucoepidermoid carcinoma of the right submandibular gland, previously treated with surgical resection and radiotherapy. The patient, a long-term worker in a rubber factory, presented with a painless, firm swelling in the right cheek, persisting for three months. Contrast-enhanced computed tomography (CECT) showed distended facial vein with enhancing thrombus confirmed by sonographic correlation demonstrating intralesional vascularity. Cannon ball pulmonary nodules were also noted. Radiological findings led to a core biopsy, confirming tumor thrombosis of the facial vein due to mucoepidermoid carcinoma. However, the patient declined a biopsy of the pulmonary nodules, and has been referred to oncology for further management.

Conclusions: This case highlights the critical importance of considering venous tumour thrombus in patients with previous salivary gland malignancies presenting with new or persistent facial swellings. It emphasises the role of advanced imaging techniques in the early identification of this rare entity. Additionally, it stresses the need for healthcare providers to engage in thorough discussions with patients about the potential consequences of forgoing recommended treatments, reinforcing the need for vigilance in monitoring such patients.

Learning points: Tumours of head and neck may cause thrombosis of veins by direct invasion resulting in a tumour thrombus, or indirectly by exerting a mass effect and vein compression.These can be distinguished by contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI).Doppler ultrasound may show patchy neovascularisation in a tumour thrombus, which would be absent if thrombosis was caused by compression.

来自颌下腺黏上皮样癌的面部静脉瘤栓:头颈部癌症的非典型肿瘤扩散。
背景:面部静脉肿瘤血栓是唾液腺黏液表皮样癌引起的一种极为罕见的并发症。早期发现对于适当的治疗至关重要,因为延误治疗会导致转移性疾病,使预后恶化:本病例涉及一名 76 岁的男性,右侧颌下腺粘液表皮样癌,曾接受过手术切除和放射治疗。患者长期在橡胶厂工作,出现右侧面颊无痛、坚实肿胀,持续三个月。对比增强计算机断层扫描(CECT)显示,面部静脉扩张,血栓增强,声像图相关性证实了区域内的血管性。此外,还发现了炮弹状肺部结节。根据放射学检查结果,患者接受了核心活组织检查,确诊为粘液表皮样癌导致的面部静脉肿瘤血栓形成。然而,患者拒绝对肺部结节进行活检,并被转到肿瘤科接受进一步治疗:本病例强调了在既往患有唾液腺恶性肿瘤并出现新的或持续性面部肿胀的患者中考虑静脉肿瘤血栓的重要性。它强调了先进的成像技术在早期识别这种罕见实体方面的作用。此外,它还强调医疗服务提供者需要与患者就放弃推荐治疗的潜在后果进行充分讨论,并加强对此类患者的监测:头颈部肿瘤可能通过直接侵犯导致肿瘤血栓形成,也可能通过肿块效应和静脉压迫间接导致静脉血栓形成,这两种情况可通过对比增强计算机断层扫描(CECT)或磁共振成像(MRI)加以区分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
166
审稿时长
8 weeks
期刊介绍: The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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