WSI23-88: Practical Cases – Head & Neck Pathology

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Request type Study

Subspecialty Head and Neck

Set Current Concepts in Head and Neck and Endocrine Pathology

Topic Practical Cases – Head & Neck Pathology

Presenter Faquin, William C.,MD, PhD

Date and time Friday, June 9, 2023 5:00 AM

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Case	Clinical history	Requester	Diagnosis
Case	Clinical history	Requester	Diagnosis
Case 1	20 year old female with floor of mouth tumor.	Kx601	Adamantinoma-like Ewing's sarcoma. (FISH is + for EWSR fusion)
Case 2	67 year old male with left maxillary sinus cancer.	Kx601	NUT carcinoma
Case 3	74 year old female with chronic otitis media and middle ear mass.	Kx601	Phosphaturic mesenchymal tumor.
Case 4	38 year old woman with mass adjacent to/adherent to thyroid gland.	Kx601	Parathyroid carcinoma (1.2 cm) • with tumor infiltrating thyroid gland and suspicious for lymphovascular invasion.
Case 5	70 year old female with a mass arising in the sinonasal tract.	Kx601	SWI/SNF complex-deficient sinonasal carcinoma with SMARCB1 loss.
Case 6	55 year old man with a one year of nasal congestion • epistaxis and drainage • and a large mass in the right nasal cavity	Kx601	HPV-related multiphenotypic sinonasal carcinoma • previously called HPV-related adenoic cystic-like carcinoma
Case 7	82 year old male with left parotid mass.	Kx601	Metastatic renal cell carcinoma.
Case 8	33 year old diagnosed with papillary thyroid carcinoma in 2012. Lesion was a 2.0 cm in the right lobe with minimal extrathyroidal extension and two negative lymph nodes (currently would have been classified as pT1b N0a -- then pT3 N0). All was fine until July 2020 noted to have LUL lung lesion excised and RUL lung lesion excised Aug 2020. Jan 2021 • noted to have two brain lesions (L frontoparietal and R occipital). Tumor noted to have CCDC149-ALK fusion. Subsequently treated with SAS (stereotactic ablative surgery -- gamma knife). Now alectinib.	Kx601	Kinase fusion-related thyroid carcinoma (for now • associated with classical papillary thyroid carcinoma). Alectinib targets ALK (anaplastic lymphoma kinase)
Case 9	21 year old man with presents with changes in phonation and a multifocal thyroid masses	Kx601	fusion kinase-related papillary thyroid carcinoma • multifocal (up to 2.9 cm) with extrathyroidal extension and neural involvement and extensive lateral neck mets. Grossly involving recurrent laryngeal nerve and ligament of Berry (pT4a). Positive for NCOA-RET fusion; selpercatinib (RET inhibitor) pre and post-operatively