A 55-year-old male, smoker and moderate drinker, with a history of intervened pulmonary hamartoma.
He was diagnosed with epidermoid nonkeratinizing carcinoma in the right soft palate (pT3N1M0).
Exeresis, functional neck dissection, failed radial free flap reconstruction, and a rescue pectoral were performed.
She received 66Gy of adjuvant radiotherapy for an involved margin and 1/20 positive nodes.
After 7 years and 3 months of follow-up there is no suspicion of recurrence. Only one pulmonary nodule (NP) is found without metabolic translation, until a polypoid exophytic lesion of 16 × 12 mm appears in the intervened area.
Incisional biopsy revealed an ulcerated mucosa with abundant inflammatory and psychiatric component, epithelial hyperplasia and keratosis.
The Positron Emissionmography-Computed Tomography (PET-CT) evidences an SUVmax 5.0 uptake in the lesion, several cervicothoracic ganglia in stable NP and neck.
Biochemical, hematological and coagulation analyses are normal.
Exeresis of the lesion and direct closure were performed.
The initial anatomopathological results are inconclusive and the study is extended with immunohistochemical markers compatible with HS:
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Positive: CD45, CD45RO, CD163, CD68, CD4, lysozyme and vimentin.
Ms Sola, AE, 5.2, CD21, CD1a, CD30, EMA, ALK, CD20, CD3, actin, desmin, calponin, myelooperoxidase, CD3199,
Proliferative index Ki67: 15%.
1.
PET-CT 2 months after surgery showed a persistence of SUVmax uptake in bed, reduction of adenomegaly and PN without changes.
Expectant management was decided with periodic controls.
After 12 months, another PET-CT showed no intraoral changes, but PN progressed poorly defined as lepid adenocarcinoma, and differentiated cervicothoracic squamous cell carcinoma SUVmax 9.3 and 11.0 respectively.
Currently, the patient is undergoing radiotherapy for lymph node disease.
