A lucky bullet in the neck: Incidental carcinoma of unknown primary found during a gunshot wound repair

Otolaryngology Case Reports

Peter T. Dziegielewski¹  Emma J. Djabali² 

[1] Corresponding author.;College of Medicine, University of Florida, Gainesville, FL, USA;

关键词: Incidental;    Cancer;    Trauma;    Gunshot wound;    Squamous cell carcinoma;    Head and neck;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: The incidental finding of squamous cell carcinoma (SCC) in cervical lymph nodes during neck exploration for non-oncologic surgery is not reported in the literature. This study presents the first-ever reported incidentally found SCC in the neck during a penetrating neck trauma repair. The approach, clinical implications, and treatment are discussed. Case presentation: A 58-year-old otherwise healthy male was taken to an outside emergency department following a near-fatal gunshot wound to his neck with a large pharyngeal defect. During the neck exploration, several firm enlarged upper cervical lymph nodes were sent for frozen section pathology, which came back suspicious for SCC. A comprehensive neck dissection was completed and the remaining lymph nodes were excised. The patient underwent a pharyngoplasty and neck skin reconstruction with a bi-lobed anterolateral thigh (ALT) free flap. Final pathology identified the neck nodes to be positive for moderately differentiated human papillomavirus negative SCC. The patient underwent treatment for cancer of unknown primary with chemoradiation therapy. PET-CT imaging 1-year postoperatively was negative for persistent or recurrent disease. The patient was without signs of recurrence at his 18-month follow-up with a viable ALT flap at the site of reconstruction. Discussion: Incidental cancer diagnosis during surgery following trauma is rare. These circumstances make a case for routine examination of lymph nodes during surgery.

【 授权许可】

Unknown