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Paranasal sinus and nasal cavity neoplasms
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
US is an excellent modality for the assessment and surveillance of the cervical nodes and can be used to guide fine-needle aspiration cytology (FNAC). Its resolution is excellent, beyond that of CT and MRI. However, it cannot detect retropharyngeal lymph nodes and must, therefore, be used in conjunction with cross-sectional imaging. In patients with a palpable neck mass, US can be used to guide FNAC or core biopsy and to diagnose the presence of metastatic neck nodes. The specificity of US FNAC for neck nodes is very high (136–139). The 1 cm short axis size criterion has poor sensitivity for the detection of nodal metastases (140). Taking account of the shape, contour, echogenicity, grouping, internal architecture, necrosis, and pattern of Doppler vascularity enhances the accuracy of US for nodal metastases to >90% (141). US can detect ENE with an accuracy of up to 79% (142). Newer techniques such as US elastography are under investigation but remain inconclusive (143).
Animal Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
As expected, the clinical symptoms of the pulmonary form include a chronic cough due to granulomatous, caseous, necrotizing inflammation in the lungs and associated lymph nodes,12 the commonest of which to be affected are the bronchial, mediastinal, retropharyngeal, and portal lymph nodes. Enlargement of other lymph nodes can also be detected and tubercles can also be discovered in the liver, spleen and body cavities. In advanced cases of the disease, enlarged lymph nodes have the potential to cause significant obstruction, for example, of the trachea, alimentary tract, or blood vessels. Enlargement of the peripheral lymph nodes can be viewed on external examination, and these nodes have the potential to rupture and their caseous contents to drain. Symptoms due to the involvement of the digestive tract may include intermittent diarrhea and bloating, due to the presence of enlarged mediastinal lymph nodes and retropharyngeal lymph node enlargement can lead to dysphagia. Clinical symptoms can therefore be attributed to the organs involved and may vary between cases. They may include weight loss, weakness, inappetence, fluctuating fever, an intermittent hacking cough, diarrhea, anorexia, and induration of the udder, depending on the manifestation of the disease. Tuberculous mastitis in cattle is a major public health concern, as the disease can spread easily from infected cattle to both calves and humans consuming the milk, and mastitis caused by M. bovis is clinically indistinguishable from other forms of mastitis.
Oropharynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
The retropharyngeal space runs from the base of the skull to the level of T6, posterior to the pharynx and oesophagus. Retropharyngeal lymph nodes are found in the portion of the retropharyngeal space superior to the hyoid bone. These lymph nodes drain the pharynx, nasal cavity, paranasal sinuses and the middle ear. Thus, infections in the pharynx can potentially lead to suppurative lymphadenopathy and abscess formation in this space. These lymph nodes are more prominent in children, and largely atrophy by adulthood, explaining why retropharyngeal abscesses are more common in young children and adolescents. The contents include areolar fat, lymph nodes and small vessels.
Real World Presentation and Treatment Outcomes with a Predominant Induction Chemotherapy Based Approach in Nasopharyngeal Carcinoma: A Sixteen Year Report from a Teaching Hospital in India
Published in Cancer Investigation, 2023
Ramana Gogi, Aparna Sharma, Atul Sharma, BK Mohanti, Raja Pramanik, Suman Bhasker, Ahitagni Biswas, Alok Thakar, Amit Chirom Singh, Kapil Sikka, Rajeev Kumar, Sanjay Thulkar, Sudhir Bahadur
The patients were treated with definitive radiotherapy (RT) to a dose of 66–70 Gray in 33–35 fractions over 6.5–7 weeks. A dose of 66 Gray was advocated for RT in pediatric patients with NPC. Radiation was delivered once daily, five fractions per week. The RT technique had gradually evolved from two-dimensional conventional RT (2D-CRT) to three-dimensional conformal RT (3D-CRT) to intensity-modulated radiation therapy (IMRT), over the study period. In the transition periods, RT boost was planned by 3D-CRT and IMRT techniques after the initial phase of RT by 2D-CRT and 3D-CRT techniques, respectively. Gross primary and nodal disease were boosted up to a dose of 66–70 Gray whereas 50–56 Gray was used for the eradication of subclinical microscopic disease. Regarding cervical lymph nodes, levels Ib–V and VIIa (retropharyngeal lymph nodes) were bilaterally included in the RT portal in all patients. Spinal cord was spared at 44 Gray and posterior neck nodes were boosted with electron beam (9–12 MeV) thereafter. At 56 Gray, RT boost was administered to gross primary and nodal disease. Treatment was delivered by either cobalt-60 gamma rays (in 2D-CRT) or 6 MV X-rays (in 3D-CRT/IMRT) on a medical linear accelerator.
Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma
Published in Acta Oncologica, 2019
Robin J. D. Prestwich, Louise J. Murray, Gillian F. Williams, Emma Tease, Lucy Taylor, Cathryn George, Kate Cardale, Karen E. Dyker, Patrick Murray, Mehmet Sen, Satiavani Ramasamy
A compartmental approach to target volume delineation was used during this era of 20102014, in line with the approach in the PARSPORT study [32], and as previously described [23,31]. Primary tumour CTV included the GTV plus 10 mm and the anatomical compartment i.e., the whole oropharynx, edited to anatomical boundaries to exclude air and/or bone without evidence of invasion. The high-dose nodal CTV included the whole involved nodal level. Radiologically uninvolved nodal levels were treated at an intermediate or lower dose level according to clinician preference. Retropharyngeal lymph nodes were routinely included in cases with positive level II lymph nodes and/or posterior pharyngeal wall involvement. A PTV was created by an isotropic expansion of 4 mm. The standard dose was 70 Gy in 35 fractions over 7 weeks. The dose to the elective target volume was 57 Gy in 35 fractions with an intermediate dose level of 63 Gy in 35 fractions used at clinician discretion. Treatment was delivered using a 5–7 angle step and shoot IMRT technique.