BACKGROUND

Penile squamous cell carcinoma (SCC) is rare in high-income regions but remains a significant oncologic burden worldwide. Nodal involvement is the most important prognostic factor, and early identification is critical.

THE CASE

A 56-year-old circumcised male presented with a six-month history of a progressively enlarging, foul-smelling fungating penile mass and bilateral inguinal lymphadenopathy. Biopsy confirmed moderately differentiated SCC. Imaging showed large bilateral inguinal nodal disease without distant metastasis. Laboratory findings revealed leukocytosis, thrombocytosis, and mildly deranged coagulation parameters. The patient underwent total penectomy with perineali urethrostomy, followed by bilateral inguinal and pelvic lymph node dissection through single-curvilinear incisions. Frozen-section analysis confirmed extensive bilateral nodal metastasis. Postoperatively, a localized left inguinal surgical site infection was treated conservatively. He was discharged on postoperative day seven with drains in situ and was recommended adjuvant chemoradiotherapy in accordance with NCCN Guidelines.

CONCLUSION

This case highlights the challenges of managing advanced penile SCC with bulky bilateral inguinal metastasis and demonstrates the utility of single-curvilinear inguinal incisions for comprehensive lymphadenectomy. Early recognition, accurate staging, and guideline-based multimodal treatment remain essential for optimizing outcomes.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Carcinoma, Squamous Cell ; Lymph Node Excision

An elderly Filipino female presented with a 5-year enlarging left nasolacrimal mass initially diagnosed as Inverted Papilloma of the Lacrimal Sac. Repeat biopsy revealed a papillomatous neoplasm with thick and thin papillae, solid invaginating lobules, and anastomosing trabeculae of monomorphic squamotransitional cells, briskly infiltrated by neutrophils. Mucocytes, respiratory epithelium, and microcysts, typical of Inverting Sinonasal Papilloma, are absent. Immunohistochemistry, including a validated AFF2 IHC, confirmed the diagnosis of DEK::AFF2 sinonasal carcinoma. Awareness of this emerging entity is essential to prevent misdiagnosis and prompt surgical management.

Human ; Carcinoma, Squamous Cell ; Philippines

Introduction: Pancreatoblastoma is a rare tumor predominantly affecting pediatric population and accounts for 0.5% of all pancreatic tumors. Overlapping histologic features with other neoplasms in a limited sample poses a diagnostic challenge in rendering final diagnosis for appropriate management. Case Description: A 6-year-old female presented with abdominal mass. Imaging revealed a pancreatic mass initially measuring 8.9 cm enlarging to 20.8 cm in the span of 3 months with elevated serum AFP levels. Biopsy and subsequent immunohistochemistry was interpreted as malignant round cell neoplasm. Neoadjuvant chemotherapy was initiated and underwent distal pancreatectomy. Grossly, there was an ill defined, tan, solid mass measuring 10.0 x 8.0 x 8.0 cm and histology revealed lobules separated by dense fibrous bands with acinar and trabecular patterns and featured prominent squamous morules. Patient was discharged stable with normalization of serum AFP and started adjuvant chemotherapy. Discussion: Biopsy showed round cells which are beta-catenin positive and synaptophysin, chromogranin A negative with an impression of solid pseudopapillary neoplasm versus pancreatoblastoma. Thorough sampling of the resection specimen showed lobules of malignant cells positive for pancytokeratin and E-cadherin confirming epithelial differentiation and the diagnostic squamous morules showed CD10 positivity and a distinct pattern of both nuclear and cytoplasmic betacatenin expression supporting the activation of Wnt pathway that is typical of pancreatoblastoma. Conclusion Limited tissues due to large tumor size and core biopsy sampling did not reveal the characteristic squamous morules, thus having a diagnostic challenge. Comprehensive evaluation of the resected specimen addressed this gap by having more tumoral areas and specific tissues subjected to immunohistochemistry studies.
Child ; Pancreatoblastoma ; alpha-Fetoproteins ; Carcinoma, Squamous Cell

Basal Cell Nevus Syndrome (BCNS) is a rare autosomal dominant disorder characterized by a range of abnormalities, most notably multiple basal cell carcinomas (BCCs), odontogenic keratocysts, and palmar and/or plantar pits. BCC is the most common form of skin cancer globally. It is typically locally invasive and very rarely metastasizes, with distal metastases occurring in only 0.00028% to 0.55% of cases.

We present a case of a 68-year-old Filipino woman who was diagnosed with BCNS. She presented with multiple black nodules and plaques on her face and neck, histopathologically confirmed as BCCs. In addition, the presence of palmoplantar pits and calcification of the falx cerebri met three of the six major criteria for BCNS. Computed tomography (CT) and bone scans, revealed multiple bone metastases in the cranium, spine, sternum, and ribs. No previous cases of metastasis in a BCNS patient have been reported in the Philippines, making this the first documented case.

Human ; Female ; Aged: 65-79 Yrs Old ; Basal Cell Nevus Syndrome ; Carcinoma, Basal Cell

OBJECTIVE

To report a case of parotid cholesteatoma and concurrent squamous cell carcinoma of the temporal bone in a 51-year-old woman.

METHODS

Design: Case Report

Setting: Tertiary Government Training Hospital

Patient: One

RESULTS

A 51-year-old woman with a left parotid mass and ipsilateral external auditory canal mass and chronic bilateral otorrhea had parotid biopsy histological features of cholesteatoma and temporal bone imaging suggestive of middle ear cholesteatoma and possible parotid region abscess. She underwent subtotal petrosectomy, mastoid obliteration and excision of the parotid mass. Histopathological examination of the parotid mass was consistent with cholesteatoma but tissue from the middle ear cavity showed well-differentiated squamous cell carcinoma.

CONCLUSION

While cholesteatomas typically arise within the temporal bone, they may occasionally present in atypical or distant sites. In cases where a cholesteatoma demonstrates an unusual location, aggressive behavior, or atypical clinical progression, a high index of suspicion should be maintained for the possibility of an underlying or coexisting temporal bone squamous cell carcinoma.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Parotid Diseases ; Cholesteatoma ; Ear Neoplasms ; Cancer Of Ear ; Carcinoma, Squamous Cell ; Squamous Cell Carcinoma Of Head And Neck

OBJECTIVES

To report a case of triple primary malignant neoplasms in a 70-year-old woman diagnosed with follicular and papillary thyroid carcinoma and diffuse B-cell lymphoma of the right submandibular gland and cervical lymph nodes.

METHODS

Design:Case Report

Setting:Tertiary Government Training Hospital

Patient: One

RESULTS

A 70- year-old woman presented with a four-year history of gradually enlarging anterior neck mass, associated with a right submandibular mass and neck nodes for one year. The gradual progression of her symptoms made the patient think that it was a benign condition. This led to a delay in medical consultation. The patient underwent total thyroidectomy with functional neck dissection of the ipsilateral right neck. Histopathology revealed simultaneous follicular and papillary thyroid carcinoma, and diffuse B-cell lymphoma of the cervical lymph nodes. The patient was referred to medical oncology and nuclear medicine for further management.

CONCLUSION

Our patient was incidentally diagnosed with follicular and papillary thyroid carcinoma and diffuse B cell lymphoma of the cervical lymph nodes after surgery. Such triple primary malignant neoplasms in a single individual are rare, and as in our case, may only be diagnosed in hindsight.

Human ; Female ; Aged: 65-79 Yrs Old ; Carcinoma ; B-lymphocytes ; Adenocarcinoma, Follicular ; Neoplasms ; Submandibular Gland ; Lymph Nodes ; Lymphoma, B-cell ; Thyroid Gland ; Thyroid Cancer, Papillary ; Thyroidectomy

Non-small cell lung cancer(NSCLC) is the most common type of lung cancer worldwide, accounting for approximately 80%-85% of all lung cancer cases. Despite the clinical benefits of traditional treatments such as surgery, chemotherapy, and radiotherapy, challenges such as the high rate of postoperative recurrence and resistance of some patients to chemotherapy and targeted therapies limit their effectiveness, necessitating the exploration of more effective treatment options. In recent years, immunotherapy, especially immune checkpoint inhibitors(ICIs), has revolutionized NSCLC treatment and significantly improved the survival prognosis of some patients. However, the efficacy of immunotherapy is limited by tumor immune escape, drug resistance, and immune-related adverse events(irAEs), which have not been effectively addressed. Traditional Chinese medicine(TCM), as a traditional therapeutic approach, has shown unique advantages in NSCLC treatment, with studies indicating its ability to enhance immune responses, regulate immune checkpoints, and improve the tumor microenvironment(TME), thus boosting the efficacy of immunotherapy. Additionally, the multi-target and multi-pathway effects of TCM help mitigate the side effects of immunotherapy, further improving efficacy and safety. This review summarizes the latest research progress of TCM in NSCLC immunotherapy, focusing on the research results of TCM in enhancing the effect of immunotherapy by regulating immune cells, optimizing the immune microenvironment, and being applied with ICIs, etc. The latest research progress of TCM in alleviating irAEs is also elucidated. The aim is to provide theoretical support for the clinical application of TCM in the prevention and treatment of NSCLC and the research and development of new drugs and promote the optimization and development of combined immunotherapy and TCM treatment models.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; Lung Neoplasms/therapy* ; Immunotherapy/methods* ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Animals ; Tumor Microenvironment/drug effects*

OBJECTIVE: To explore the feasibility of reconstruction of phonatory function by using a tubular free flap from upper-lateral upper arm to repair the laryngotracheal circumferential defect after near-total laryngectomy for laryngeal cancer. METHODS: A retrospective study was conducted on 7 patients who underwent near-total laryngectomy between June 2021 and October 2023, aged from 48 to 70 years (median, 59 years), 6 males and 1 female. The disease duration ranged from 1 to 11 months, with a median of 6 months. Pathological diagnosis of preoperative biopsy was squamous cell carcinoma. Tumor classification: glottic type in 5 cases, supraglottic type in 1 case, transglottic type in 1 case; TNM staging: T ₄N ₀M ₀ in 6 cases, T ₄N ₂M ₀ in 1 case; American Joint Committee on Cancer (AJCC) staging in 2017 was stage Ⅳ. Preoperative MRI angiography of upper arm was performed to investigate the blood supply in the upper and lateral regions of the upper arm. After near-total laryngectomy and bilateral neck lymph node dissection, the area of the laryngotracheal defect was measured. A free flap measuring 7.0 cm×5.0 cm to 8.0 cm×7.0 cm was harvested from the upper-lateral upper arm, rolled into a tube shape, and connected between the stump of the cervical trachea in the neck root and that of the epiglottis at the tongue base. Four patients received adjuvant radiochemotherapy, 1 patient received radiochemotherapy and targeted therapy, 2 patients adopted no further adjuvant treatment. RESULTS: All 7 patients were followed-up 1-2 years (mean, 1 year and 3 months). Four patients had primary wound healing, 2 patients had minor pharyngeal fistulas that healed after dressing change, 1 patient experienced pharyngeal fistula because of flap necrosis and the wound still healed without secondary surgery. All patients took food orally within 1 month after operation, and the tracheal cannula was retained. Six patients with survived flap gradually adapted to their new pronunciation mode and obtained satisfactory phonatory function from 15 days to 2 months after operation. Four patients had slight aspiration after operation. Till the end of the follow-up, all patients survived and no local recurrence or distant metastasis had been observed. The motor function of the upper arm was not affected, only partial sensory loss occurred in the area near the incision. The scar of the incision could be covered by the short sleeve so as to obtain a better aesthetic effect. CONCLUSION Using a tubular free flap from upper-lateral upper arm to repair the laryngotracheal circumferential defect after near-total laryngectomy for laryngeal cancer can achieve satisfactory phonatory restoration while preserve the motor function and aesthetics of the donor site.
Humans ; Laryngectomy/methods* ; Male ; Middle Aged ; Female ; Laryngeal Neoplasms/surgery* ; Aged ; Free Tissue Flaps ; Retrospective Studies ; Plastic Surgery Procedures/methods* ; Carcinoma, Squamous Cell/surgery* ; Phonation ; Arm/surgery* ; Neck Dissection

OBJECTIVE: To evaluate the effectiveness of the innervated medial plantar flap for reconstructing soft tissue defects, particularly in the weight-bearing zone, after resection of foot tumors. METHODS: A retrospective analysis was conducted on 12 patients with malignant skin and soft tissue tumors of the foot treated between October 2023 and December 2024. The cohort included 8 males and 4 females, aged 42-67 years (mean, 57.5 years). Tumor types comprised malignant melanoma (5 cases), squamous cell carcinoma (4 cases), arsenical keratosis (2 cases), and tumor-induced osteomalacia (1 case). Soft tissue defects located in the heel weight-bearing region in 10 cases and non-weight-bearing ankle region in 2 cases, with defect sizes ranging from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. Preoperative photon-counting CT angiography (PC-CTA) was performed to assess the medial plantar artery and its perforators. All patients underwent radical tumor resection with confirmed negative margins. The resulting defects were reconstructed using a innervated medial plantar flap incorporating sensory branches of the medial plantar nerve. The flap donor site was covered with a split-thickness skin graft harvested from the ipsilateral inguinal region. RESULTS: The operation was successfully completed in all 12 patients. All flaps survived completely without vascular compromise, partial necrosis, or total loss. Incisions healed primarily without dehiscence or infection. Minor skin graft necrosis occurred at the donor site in 3 patients, which healed within 2-3 weeks with routine dressing changes. No donor site complication (e.g., tendon or nerve injury) occurred. Patients were followed up 2-16 months (mean, 10.3 months). At last follow-up, there was no tumor recurrence. Flaps exhibited good color and texture match with surrounding tissue, restored sensation, and all feet achieved normal weight-bearing activity. CONCLUSION The innervated medial plantar flap, precisely designed based on PC-CTA localization, provides reliable blood supply and effective sensory restoration. It is an ideal method for reconstructing soft tissue defects after foot tumor resection, especially in the heel weight-bearing region.
Humans ; Male ; Middle Aged ; Female ; Plastic Surgery Procedures/methods* ; Adult ; Aged ; Retrospective Studies ; Soft Tissue Neoplasms/surgery* ; Surgical Flaps/blood supply* ; Foot/surgery* ; Skin Neoplasms/surgery* ; Soft Tissue Injuries/surgery* ; Carcinoma, Squamous Cell/surgery* ; Treatment Outcome ; Skin Transplantation/methods* ; Melanoma/surgery*

OBJECTIVE: To explore the technical key points and effectiveness of the facial artery perforator myomucosal flap (FAPMF) in repairing oral and perioral tissue defects. METHODS: Between June 2023 and December 2024, 8 patients with oral and perioral tissue defects were repaired with the FAPMF. There were 4 males and 4 females, with an average age of 57.6 years (range, 45-72 years). Among them, 4 cases had floor-of-mouth defects and 3 cases had buccal mucosa defects remaining after squamous cell carcinoma resection, and 1 case had lower lip defect caused by trauma. The size of tissue defects ranged from 4.5 cm×3.0 cm to 6.0 cm×5.0 cm. The preoperative mouth opening was (39.55±1.88) mm, and the preoperative swallowing score of the University of Washington Quality of Life Questionnaire (UW-QOL) was 64.64±8.47. Preoperatively, CT angiography and Doppler ultrasound were used to locate the perforator vessels. A myomucosal flap pedicled with the perioral perforators of the facial artery was designed, with the harvesting size ranging from 4.0 cm×2.5 cm to 6.5 cm×4.0 cm. The length of the vascular pedicle was 4.2-6.8 cm (mean, 5.2 cm). Postoperatively, FAPMF survival, complications, and functional recovery were observed. RESULTS: All 8 surgeries were successfully completed without conversion to other repair methods or complications such as facial nerve injury. The total operation time ranged from 110 to 180 minutes, with an average of 142.5 minutes; among this, the harvesting time of the FAPMF ranged from 35 to 65 minutes, with an average of 48.7 minutes. The intraoperative blood loss was 50-150 mL, with an average of 85.6 mL. All FAPMFs survived completely. One patient developed venous reflux disorder at 24 hours after operation, which relieved after conservative treatment. All patients were followed up 7-16 months (mean, 12.4 months). All FAPMFs achieved complete epithelialization at 3 months after operation, showing a similar soft texture to the surrounding mucosa. At 7 months after operation, the mouth opening was (39.11±1.79) mm, slightly lower than preoperative level, but the difference was not significant (P>0.05). The swallowing score of the UW-QOL was 63.78±8.31, which was significantly lower than preoperative score (P<0.05). The visual analogue scale (VAS) score for patient satisfaction was 7-10, with an average of 8.9. CONCLUSION The FAPMF has advantages such as reliable blood supply, high mucosal matching degree, and concealed donor site, making it an ideal option for repairing small and medium-sized oral and perioral tissue defects.
Humans ; Male ; Middle Aged ; Female ; Perforator Flap/blood supply* ; Aged ; Plastic Surgery Procedures/methods* ; Mouth Neoplasms/surgery* ; Mouth Mucosa/surgery* ; Mouth/surgery* ; Quality of Life ; Face/surgery* ; Treatment Outcome ; Carcinoma, Squamous Cell/surgery* ; Arteries/surgery*