Clinical report highlights how disease progression can mimic head, neck cancer
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A 42-year-old male was recently fitted for occupational ear molds to protect him from excessive noise exposure at work and further hearing loss. During the fitting, he experienced severe, sudden otalgia and vertigo and complained that hearing loss in the left ear, his better-hearing ear, had worsened.
A 75-year-old man presented with a left ear lobule melanoma and was found, on examination, to have a concurrent right parotid mass and bilateral cervical lymphadenopathy. A CT scan of the neck confirmed a 2-cm right superficial parotid mass containing both solid and cystic components without any pathognomonic characteristics, as well as bilateral cervical lymphadenopathy with multiple 2- to 3-cm lymph nodes. FNA biopsy of the parotid mass was consistent with carcinoma, whereas FNA samples from the cervical lymph nodes were non-diagnostic.
A 78-year-old woman presented with a 10-year history of progressive dysphagia for solid foods and pills, with intermittent regurgitation of pills but not food. No aspiration or weight loss was reported. Her past medical history was significant for breast cancer, hypothyroidism and arthritis. No head and neck masses were appreciated. A modified barium swallow was obtained.
A 14-year-old boy sustained blunt trauma to the forehead from a foul-tipped baseball. Significant past medical history consisted of allergic rhinitis treated with over-the-counter cetirizine (Zyrtec). On examination, the patient had right frontal sinus depression with overlying edema. There were no palpable nasal bone or orbital rim abnormalities. Baseball threads were seen on the overlying skin as well as ecchymosis on the nasal dorsum and under both eyes.